Drug survival of biologic therapy in a large, disease‐based registry of patients with psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR)

Abstract

Background Drug survival is a marker for treatment sustainability in chronic diseases such as psoriasis.ObjectiveThe aim of these analyses was to assess survival of biologic treatments in the PSOriasis Longitudinal Assessment and Registry (PSOLAR).Methods PSOLAR is a large, prospective, international, disease‐based registry of patients with psoriasis receiving (or eligible for) systemic therapy in a real‐world setting. Drug survival is defined as the time from initiation to discontinuation (stop/switch) of biologic therapy on registry. The number of patients who discontinued each treatment and the duration of therapy were recorded. Using Kaplan–Meier survival curves and Cox‐regression analyses [hazard ratios (HR) and 95% confidence intervals (CIs)], time to discontinuation was compared across cohorts undergoing first‐, second‐ or third‐line treatment with ustekinumab, infliximab, adalimumab or etanercept.ResultsAs of the 2013 data cut, 12 095 patients with psoriasis were enrolled in PSOLAR. Of the 4000 patients initiating any new biologic therapy, approximately 3500 started a first‐line, second‐line or third‐line biologic therapy during the registry. Lack of effectiveness was the most common reason for discontinuation across biologic therapies. Based on the multivariate analysis, significantly shorter times to discontinuation were observed for infliximab [HR (95%CI) = 2.73 (1.48–5.04), P = 0.0014]; adalimumab [4.16 (2.80–6.20), P < 0.0001]; and etanercept [4.91 (3.28–7.35) P < 0.0001] compared with ustekinumab [reference treatment]) for first‐line biologic use; results were similar for treatment effects for second/third‐line therapies. Although limited in power, analyses in patients with concurrent psoriatic arthritis confirmed by a rheumatologist reflect observations in the overall psoriasis population.ConclusionDrug survival was superior for ustekinumab compared with infliximab, adalimumab and etanercept in patients with psoriasis.

Long-term drug survival and predictor analysis of the whole psoriatic patient population on biological therapy in Hungary

“…Table 3 summarizes all the studies published so far, where data were collected from large patient population of two or more centers, the follow-up period was at least one year, and the authors compared at least three or more biological therapies. The list includes five prospective registry-based studies and three retrospective studies (5,11,(16)(17)(18)(19)(20). Table 3 shows that those studies which included ustekinumab have found drug survival of ustekinumab superior to the drug survival of TNF-alpha inhibitors.…”

Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

“…A possible explanation may be previous therapeutic failure during infliximab treatment. Nevertheless, there are also reports that ustekinumab is effective in long-term therapy both in patients previously treated with biologics and taking ustekinumab as the first drug [22]. The study has also shown that ustekinumab is the drug which can be maintained for longer than other available drugs in patients with arthritic psoriasis.…”

“…ności tych leków podczas długotrwałego stosowania oraz że pewne grupy pacjentów gorzej odpowiadają na leczenie. W badaniach porównujących długotermi-nowe działanie i bezpieczeństwo leków biologicznych zauważono, że główną przyczyną przerywania terapii była utrata skuteczności leków [21][22][23][24]. W jednej z prac wzięło udział 1277 pacjentów leczonych ustekinumabem (anty-IL-12/IL-23), adalimumabem (anty-TNF-α), infliksymabem (anty-TNF-α) lub etanerceptem (białko fuzyjne -p75, ludzki receptor TNF-α połączony z Fc IgG1).…”

“…Jedną z hipotez może być wcześniejsze niepowodzenie terapeutyczne podczas stosowania infliksymabu. Istnieją jednak doniesienia mówiące o tym, że ustekinumab jest skuteczny w długotrwałej terapii zarówno u pacjentów stosujących wcześniej leki biologiczne, jak i u tych, u których ustekinumab był pierwszym lekiem [22]. W pracy wykazano także, że u chorych na łusz-czycę stawową ustekinumab jest lekiem, który udaje się stosować dłużej niż pozostałe preparaty.…”

“…Wielu A growing body of studies demonstrate that there are factors making biologic drugs ineffective during prolonged use, and that certain groups of patents show a poorer response to treatment. Studies comparing long-term activity and safety of biologic drugs have found that the main reason for the discontinuation of therapy was the loss of drug efficacy [21][22][23][24]. In one of the studies, including a total of 1,277 patients treated with ustekinumab (anti-IL-12/IL-23), adalimumab (anti-TNF-α), infliximab (anti-TNF-α) or etanercept (fusion protein -human p75 TNFα receptor with Fc-IgG1), the longest treatment period was maintained for ustekinumab, followed by TNF-α inhibitors (average: 59 months -adalimumab, and 44 months -infliximab), and the shortest -for etanercept (average: 30 months) [21].…”