“…Moreover, in our study, patients who received two or more biologicals with different mechanisms of action before SEC discontinued treatment before naı ¨ve patients. On the contrary, in our study, coinciding with the case series by Yiu et al [10], but in disagreement with other studies [4,5,15,17], psoriatic arthritis was associated with a longer S-SEC.…”
Section: Discussioncontrasting
confidence: 97%
“…Although some real-world evidence (RWE) studies reporting the rates of S-SEC in psoriasis patients are available [2][3][4][5][6][7][8][9][10][11][12][13][14][15], scarce evidence about survival C 2 years has been collected [16][17][18][19][20]. In most of the RWE studies included in two meta-analyses [6,13], the patients were followed for a period shorter than 1 year.…”
Section: Discussionmentioning
confidence: 99%
“…Secukinumab (SEC) is a fully human monoclonal IgG1/j isotype antibody that selectively binds to and neutralizes interleukin 17A (IL-17A), a proinflammatory cytokine with key involvement in the clinical manifestation of psoriasis [1]. Despite its high effectiveness and safety profile demonstrated in the treatment of moderateto-severe plaque psoriasis, there is limited and conflicting evidence over the real-world drug survival of secukinumab in patients with psoriasis [2][3][4][5][6][7][8][9][10][11][12][13][14][15], especially in the long term [16][17][18]. Moreover, there is also a great variability in the results related to the predictors of a greater or lesser survival.…”
Introduction: There is limited and conflicting evidence over the real-world drug survival of secukinumab (SEC) in patients with psoriasis, especially in the long term. Our objective was to analyze the short-and long-term survival of SEC (S-SEC) and its predictive factors for the treatment of psoriasis. Methods: Patients clinically diagnosed with plaque psoriasis and under treatment with secukinumab (n = 384) in a daily practice setting were analyzed in a retrospective, multicenter study performed in a nationwide cohort and followed up for a period of 2 years. Kaplan-Meier curve was plotted to analyze drug E. Daude ´n (&) Á G.
“…Moreover, in our study, patients who received two or more biologicals with different mechanisms of action before SEC discontinued treatment before naı ¨ve patients. On the contrary, in our study, coinciding with the case series by Yiu et al [10], but in disagreement with other studies [4,5,15,17], psoriatic arthritis was associated with a longer S-SEC.…”
Section: Discussioncontrasting
confidence: 97%
“…Although some real-world evidence (RWE) studies reporting the rates of S-SEC in psoriasis patients are available [2][3][4][5][6][7][8][9][10][11][12][13][14][15], scarce evidence about survival C 2 years has been collected [16][17][18][19][20]. In most of the RWE studies included in two meta-analyses [6,13], the patients were followed for a period shorter than 1 year.…”
Section: Discussionmentioning
confidence: 99%
“…Secukinumab (SEC) is a fully human monoclonal IgG1/j isotype antibody that selectively binds to and neutralizes interleukin 17A (IL-17A), a proinflammatory cytokine with key involvement in the clinical manifestation of psoriasis [1]. Despite its high effectiveness and safety profile demonstrated in the treatment of moderateto-severe plaque psoriasis, there is limited and conflicting evidence over the real-world drug survival of secukinumab in patients with psoriasis [2][3][4][5][6][7][8][9][10][11][12][13][14][15], especially in the long term [16][17][18]. Moreover, there is also a great variability in the results related to the predictors of a greater or lesser survival.…”
Introduction: There is limited and conflicting evidence over the real-world drug survival of secukinumab (SEC) in patients with psoriasis, especially in the long term. Our objective was to analyze the short-and long-term survival of SEC (S-SEC) and its predictive factors for the treatment of psoriasis. Methods: Patients clinically diagnosed with plaque psoriasis and under treatment with secukinumab (n = 384) in a daily practice setting were analyzed in a retrospective, multicenter study performed in a nationwide cohort and followed up for a period of 2 years. Kaplan-Meier curve was plotted to analyze drug E. Daude ´n (&) Á G.
Background and Objective
The most recently approved biologics for moderate-to-severe psoriasis are the interleukin (IL)-17 and IL-23 inhibitors. Drug survival is a frequently used outcome to assess drug performance in practice. An overview of the available drug survival studies regarding IL-17 and IL-23 inhibitors is lacking. Therefore, our objective was to assess the drug survival of IL-17 and IL-23 inhibitors for psoriasis.
Methods
A search of PubMed, Embase, Cochrane Library and Web of Science was conducted (last search 27 December, 2023). Inclusion criteria were (1) cohort study; (2) patients aged ≥ 18 years with plaque psoriasis; and (3) evaluation of drug survival of at least one of the IL-17 and IL-23 inhibitors. Exclusion criteria were: primary focus on patients with psoriatic arthritis, fewer than ten study subjects and another language than English. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Survival probabilities at monthly intervals were extracted from Kaplan–Meier curves using a semi-automated tool. Data were pooled using a non-parametric random-effects model to retrieve distribution-free summary survival curves. Summary drug survival curves were constructed per biologic for different discontinuation reasons: overall, ineffectiveness and adverse events, and split for the effect modifier biologic naivety. Results were analysed separately for registry/electronic health record data and for pharmacy/claims data.
Results
A total of 69 studies aggregating drug survival outcomes of 48,704 patients on secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, and tildrakizumab were included. Summary drug survival estimates of registry/electronic health record studies for overall, ineffectiveness and adverse event related drug survival were high (all point estimates ≥ 0.8 at year 1) for included biologics, with highest estimates for guselkumab and risankizumab. All estimates for drug survival were higher in biologic naive than in experienced patients. Estimates of pharmacy/claims databases were substantially lower than estimates from the primary analyses based on registry/electronic health record data.
Conclusions
This meta-analysis showed that the investigated IL-17 and IL-23 inhibitors had high drug survival rates, with highest rates for guselkumab and risankizumab drug survival. We showed that effect modifiers such as biologic naivety, and the source of data used (registry/electronic health record data vs pharmacy/claims databases) is relevant when interpreting drug survival studies.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40265-024-02028-1.
“…At 1-year, biologic agents were demonstrated to have good survival: 70% of patients on TNF-alpha inhibitors survived while 1 study showed only 34% of patients on certolizumab survived at 1 year, however, it should be noted that this study analyzed a small sample (n = 13) of patients on certolizumab. 14 Patients on IL-12/23 and IL-17 inhibitors experienced 1-year biologic survival ranging from 85% to 90%, and IL-23 inhibitors experienced the highest survival at 92% to 96% (Figure 1). Figure 1.Biologic Survival at 1 Year.…”
Section: Review Of Biologic Survival At 1- 2- and 5-yearsmentioning
Background Despite their impressive efficacy in phase 3 trials, biologic agents for psoriasis (PsO) may lose efficacy over time. The factors associated with loss of efficacy have yet to be fully elucidated. Objective We aimed to identify factors associated with PsO patients using multiple biologics in comparison to patients who used 1 biologic. We also reviewed the literature comparing the survival of different biologic agents for PsO. Methods We examined clinical data from 222 psoriasis patients at the University of California San Francisco, of whom 51 reported use of 3 or more biologics and of whom 171 reported use of only a single biologic agent at the time of enrollment into a research database from 2006-2020. This study was IRB-approved at UCSF (#10-02830) and all subjects provided written informed consent. We performed univariate and multivariate regression analysis to identify significant demographic features, clinical features, and co-morbidities associated with multi-biologic use. We performed a literature review of studies comparing psoriasis biologic survival at 1, 2, and 5 years and factors associated with single biologic failure. Results In univariate analysis, duration of PsO, initial presentation of PsO on the gluteal cleft, erythrodermic psoriasis, and acne were associated with using 3 or more biologics. In multivariate analysis, duration of PsO, erythrodermic psoriasis, and acne remained significant. Our review of biologic survival revealed differences according to biologic class. Conclusion We identified novel factors associated with multi-biologic use in PsO. Further studies in this area are needed to achieve a precision medicine approach.
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