Drug Survival of Interleukin (IL)‑17 and IL‑23 Inhibitors for the Treatment of Psoriasis: A Retrospective Multi‑country, Multicentric Cohort Study

Abstract

Background Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. Objective The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. Methods This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. ConclusionThe cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, an...

Risankizumab Therapy for Moderate-to-Severe Psoriasis—A Multi-Center, Long-Term, Real-Life Study from Poland

“…In a large, retrospective, multinational, multicentric cohort study including a total of 3145 patients, after 18 months of therapy, the drug survival rate was the highest for risankizumab among all biologic therapies targeting IL-23 and IL-17 (96.4%; with 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab and 79.9% for secukinumab) [ 17 ]. The recently published extension of this study, comprising an even higher number of study subjects ( n = 4178), showed similar results after 24 months of therapy [ 18 ]. The most important findings from real-life studies with risankizumab discussed below are summarized in Table 4 .…”

Real‐world drug survival of Brodalumab, in patients with psoriasis switched from Ixekizumab: Results of a single centre retrospective study (BroSwitch)

“…The current study was performed because in our clinical practice we noticed that more patients than expected switched back within the 1st year from Brodalumab to Ixekizumab or another biological. Our real‐world drug survival after switch from Ixekizumab 53% at Week 50, which is significantly lower than the drug survival mentioned in other studies 22,24 . These studies mention that previous biological use can negatively impact drug survival, but no specific data on Ixekizumab to Brodalumab switch was provided.…”

“…To our knowledge, this is the first description of a PsO patient group who switched from an originator biological to another originator from the same group, other than a biosimilar, not because of inefficacy but as a protocolled procedure, because of health economic reasons. Brodalumab has a 1‐year drug survival rate of 87.6%–89% at 1 year 18,22–24 …”

“…Brodalumab has a 1-year drug survival rate of 87.6%-89% at 1 year. 18,[22][23][24] Only a few studies had been performed where patients who failed on Ixekizumab were switched to Brodalumab and had favourable responses. 25,26 These two studies were limited to a duration of 16 weeks, and no drug survival was reported.…”

Effectiveness of risankizumab in the treatment of palmoplantar psoriasis: a 52-week Italian real-life experience

“… 5 Several authors have already reported their experiences in real-world clinical practice, confirming its short-term and long-term effectiveness in plaque psoriasis. 6 , 7 Some data have also been reported about its effectiveness in difficult-to-treat areas, such as nails and scalp 8 , 9 but few data are available regarding its use for PP. 9 – 13 …”