Effectiveness, Safety of Various Biologic Agents in Psoriasis Treatment

psoriasis skin disorder on an elbow
Drug survival associated with the effectiveness and safety of commonly used biologic agents for psoriasis is evaluated.

The effectiveness and safety of commonly used biologic agents for psoriasis were outlined in study data published in JAMA Dermatology. In survival analyses, guselkumab had the highest drug survival for treatment persistence and safety compared with other biologic agents. Effect modifiers included psoriatic arthritis, nail involvement, prior biologic agent exposure, and ethnicity.

Investigators extracted data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), an ongoing registry of patients with psoriasis in the United Kingdom that was established in 2007. Once enrolled, patients contribute data on their treatment regimens every 6 months for the first 3 years, then annually thereafter. Data from the start of the registry through August 2021 were used in this study. Kaplan-Meier models were used to estimate drug survival for each of the following biologic agents: adalimumab, ustekinumab, secukinumab, guselkumab, ixekizumab. Drug survival was defined as the time between treatment initiation to discontinuation. There were 2 models for drug survival fitted to the data based on 2 separate outcomes: discontinuation due to drug ineffectiveness, and ineffectiveness due to adverse events.

Data from a total of 16,122 treatment courses were included: 6607 (41.0%) initiating adalimumab; 5405 (33.5%) ustekinumab; 2677 (16.6%) secukinumab; 730 (4.5%) guselkumab; and 703 (4.4%) ixekizumab. Median patient age at treatment initiation was 46.0 years (interquartile range, 36.0-55.0 years) and median follow-up time was 2.1 years. Crude and adjusted survival rates for effectiveness were highest with guselkumab. Compared with ustekinumab, guselkumab had an adjusted hazard ratio (HR) of 0.13 (95% CI, 0.03-0.56) for discontinuation due to ineffectiveness. A lower survival was seen with adalimumab (hazard ratio [HR], 2.37; 95% CI, 2.03-2.76), indicating a nearly 3-fold increased risk for discontinuation due to ineffectiveness compared with ustekinumab. Guselkumab, ustekinumab, and secukinumab had similar adjusted survival rates for safety. Discontinuation due to adverse events was greatest with adalimumab (HR, 1.66; 95% CI, 1.46-1.89) and ixekizumab (HR, 1.52; 95% CI, 1.13-2.03) compared with ustekinumab.

Drug survival due to effectiveness was stratified by a number of patient characteristics, including psoriatic arthritis, nail involvement, and ethnicity. Patients without psoriatic arthritis or nail involvement had the highest survival with ustekinumab. Adalimumab had lower drug survival compared with ustekinumab in Asian patients (HR, 3.10; 95% CI, 2.24-4.29) than in White individuals (HR, 2.36; 95% CI, 2.02-2.76) or individuals of other racial/ethnic minority groups (HR, 2.09; 95% CI, 1.39-3.15). Previous failure with adalimumab due to ineffectiveness reduced the survival of ustekinumab; prior failure with ustekinumab reduced the survival of all biologics except guselkumab.

Results from this analysis outlined to the researchers the drug survival rates of multiple biologic agents used to treat psoriasis. Study limitations include the smaller cohort size for newer biologic agents, ixekizumab, or guselkumab, which may have introduced bias.  

“This information on longer-term treatment persistence, safety, and tolerability may help patients and their clinicians make an informed decision to initiate treatment with a biologic therapy,” investigators wrote.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Yiu ZZN, Becher G, Kirby B, et al. Drug survival associated with effectiveness and safety of treatment with guselkumab, ixekizumab, secukinumab, ustekinumab, and adalimumab in patients with psoriasis. JAMA Dermatol. Published online July 6, 2022. doi:10.1001/jamadermatol.2022.2909