Guselkumab and Risankizumab Have Highest Drug Persistence in Plaque Psoriasis

Patients with chronic psoriasis were less likely to discontinue guselkumab or risankizumab compared with other interleukin (IL)-23 or IL-17 inhibitors, data from a study published in the American Journal of Clinical Dermatology found.

In this real-world study, patients (N=4866) with moderate to severe chronic plaque psoriasis who were treated at 19 hospitals in Canada and Europe from 2015 through 2021 were evaluated for drug survival up to month 36. Patients received IL-17 inhibitors secukinumab (n=1542), ixekizumab (n=1073), or brodalumab (n=549) or IL-23 inhibitors guselkumab (n=879), risankizumab (n=693), or tildrakizumab (n=130).

The study population included individuals mean aged 52.5 (standard deviation [SD], 14.3) years, 60.7% were men, BMI was 27.9 (SD, 5.4) kg/m², 28.6% had a family history of psoriasis, they had been diagnosed 18.0 (SD, 13.1) years previously, 26.5% had psoriatic arthritis, Psoriasis Area Severity Index (PASI) score was 13.9 (SD, 7.5), 47.0% were naïve to biologic therapy, and 13.6% were naïve to systemic therapy.

A total of 18.7% of the study population discontinued their treatment course. The most common reason was loss of efficacy (15.9%), followed by safety (1.3%), loss to follow-up (0.8%), and patient decision (0.7%).

The discontinuation rates were highest for secukinumab (31.8%), followed by ixekizumab (21.5%), brodalumab (16.0%), tildrakizumab (9.2%), guselkumab (8.2%), and risankizumab (5.1%). Similarly, secukinumab had the highest discontinuation rate due to loss of efficacy (27.0% vs 4.3%-16.4%) and safety (2.2% vs 0.0%-1.9%) compared with other drugs.

Dose optimizations occurred most among secukinumab and guselkumab recipients (both 7.4%), followed by ixekizumab (6.4%), risankizumab (4.6%), brodalumab (2.4%), and tildrakizumab (1.5%). The drugs were combined with systemic therapies among 9.1% of secukinumab, 6.0% of ixekizumab, 5.8% of brodalumab, 5.0% of guselkumab, 2.5% of risankizumab, and 2.3% of tildrakizumab recipients. The most common systemic therapy combinations were methotrexate (4.1%), followed by apremilast (0.7%), cyclosporin A (0.6%), retinoid (0.6%), and phototherapy (0.2%).

In the univariate analysis, 19 sociodemographic factors were significant predictors for overall drug survival. In the multivariate analysis, risankizumab (hazard ratio [HR], 0.291; P <.001), guselkumab (HR, 0.373; P <.001), and ixekizumab (HR, 0.728; P =.001) compared with secukinumab; family history of psoriasis (HR, 0.814; P =.015); BMI at baseline (HR, 1.016; P =.020); baseline PASI (HR, 1.011; P =.013); and 1 (HR, 1.423; P <.001), 2 or 3 (HR, 1.662; P <.001), and more than 3 (HR, 2.790; P <.001) previous biologic agent failures compared with biologic-naïve factors remained significant predictors for overall drug survival.

This study may have been vulnerable to selection, information, recall, and detection biases due to its real-world design.

These data indicated to investigators that among patients with moderate to severe psoriasis, drug survival up to 36 months was higher for guselkumab and risankizumab. “Biologic drug chosen, previous exposure to biologics, baseline BMI and PASI score, and absent family history of psoriasis were all identified as predictors of drug discontinuation. Risankizumab, guselkumab, and ixekizumab were all less likely to be discontinued than secukinumab,” researchers stated.