Drug survival of ixekizumab, TNF inhibitors, and other IL‐17 inhibitors in real‐world patients with psoriasis: The Corrona Psoriasis Registry

Abstract

To compare drug survival of ixekizumab to other IL-17 inhibitors (IL-17i) and TNF inhibitors (TNFi) among patients with psoriasis (PsO) in a real-world setting. Participants included adult PsO patients enrolled in the Corrona Psoriasis Registry who initiated ixekizumab, TNFi, or other IL-17i between 16 March 2016 to 10 August 2019 and completed ≥1 follow-up visit. Multivariable adjusted hazard ratios (HR) were calculated to estimate the risk for drug discontinuation in the ixekizumab group relative to the other drugs. Among the 1604 drug initiations, 552 initiated ixekizumab, 450 initiated TNFi, and 602 initiated other IL-17i. Mean age was 51 years, 49% were women, and 52% were obese (BMI > 30). Ixekizumab patients had a higher proportion of patients with PASI >12 at drug initiation (24%) than TNFi (15%) and other IL-17i (19%). Over a median of 11 months of follow-up, 723/1604 (45%) drug discontinuations occurred. Persistence of ixekizumab, TNFi, and other IL-17i at 24-months were 68%, 33%, and 46%, among biologic-naïve patients (n = 543), and 46%, 23%, and 36%, for biologic-experienced patients (n = 1061), respectively. Ixekizumab patients had a 64% lower risk of discontinuation vs TNFi (HR = 0.36; 95% CI 0.27-0.47) and a 31% lower risk vs other IL-17i (HR = 0.69, 95% CI 0.55-0.87) after adjustment for biologic experience and other covariates. HRs were similar when limited to patients with moderate-to-severe PsO (BSA > 3, PASI > 3, and IGA > 1, n = 1076) at initiation. In our study of real-world patients with PsO, initiators of ixekizumab had more prolonged drug survival than both initiators of TNFi and other IL-17i up to 2 years of follow-up.

A Retrospective Cohort Analysis of Treatment Patterns Over 1 Year in Patients with Psoriasis Treated with Ixekizumab or Guselkumab

“…These data add to the body of evidence showing higher treatment adherence to and similar-to-longer treatment persistence with ixekizumab vs. other biologics from previous real-world studies using administrative claims data, where ixekizumab demonstrated better adherence vs. secukinumab [17] and better persistence vs. adalimumab [18] and secukinumab [9,17]. A longer drug survival vs. other IL-17 inhibitors and other biologics was also shown with ixekizumab using the Corrona (CorEvitas) Psoriasis Registry [8]. Earlier registry studies performed prior to the significant use of ixekizumab have shown mean 1-year persistence rates (based on a 90-day gap) for both first-and second-line biologics of 77% in a British cohort [11,12], 62% overall in a study assessing the French National Health Insurance database [29], and from 47% (adalimumab) to…”

“…Lack of adherence, resulting in decreased frequency of administration or interruption of therapy, is associated with the recurrence of symptoms, commonly within 2-5 months [1][2][3][4]. In addition, up to 50% of patients starting tumor necrosis factor inhibitors may discontinue within 12 months [5][6][7][8]. Notably, the rate of treatment discontinuation and switching for all biologics is substantially higher in patients previously treated with biologics vs. biologicnaı ¨ve subjects [5,7,8], and treatment persistence appears to decline with additional prior biologic therapies [9].…”

“…In addition, up to 50% of patients starting tumor necrosis factor inhibitors may discontinue within 12 months [5][6][7][8]. Notably, the rate of treatment discontinuation and switching for all biologics is substantially higher in patients previously treated with biologics vs. biologicnaı ¨ve subjects [5,7,8], and treatment persistence appears to decline with additional prior biologic therapies [9]. Finally, treatment failure and switching are reported to be associated with increased use of health care services [10][11][12][13].…”

A Machine Learning-Based Test for Predicting Response to Psoriasis Biologics

“…In particular, BMI and age have been reported as having clinical prognostic value in assessing biologic treatment response. 21,22,23 We have explored the predictive significance of BMI and age as a possible orthogonal input variable in the classifier. However, adding either variable as a covariate when exploring the predictive models, no improvement was observed in the predictive accuracy or positive predictive value (data not shown).…”

Getting personal about skin: Realizing precision medicine in dermatology

“…There are general patient stratification metrics that have been shown to have limited value in clinical practice. Specifically, patients with higher body mass index, prior biologic drug exposure, lower serum levels of drug, and lack of early response to the drug have been demonstrated to have poorer outcomes 23–27 . Studies have discovered genetic predictors for the clinical response to biologic therapy.…”