Interleukin (IL)-17 inhibitors were found to have higher treatment persistence than tumor necrosis factor (TNF) inhibitors psoriasis (PsO) and psoriatic arthritis (PsA). These findings were published in JAMA Dermatology.
This nationwide cohort study used data from the Système National des Données de Santé, the French National Health Insurance Database. Adults who used more than 2 topical vitamin D derivatives for PsO (n=16,892) or PsA (n=6531) within a 2-year period and were new users of a biologic agent from 2015 to 2019 were evaluated for biologic therapy persistence. A propensity score weighting approach was used to balance for cohort differences.
The PsO cohort (mean age, 48.5±13.8 years) and PsA cohorts (mean age, 49.1±12.8 years), 45.8% and 54.6% were women, 72.1% and 66.7% had a Charlson Comorbidity Index of 1, and 57.5% and 66.0% had been using nonbiologic agents within 2 years of the study, respectively.
Among the PsO cohort, 10,199 patients used TNF inhibitors, 3982 IL-12/23 inhibitor, and 2711 IL-17 inhibitors. For the PsA cohort, 4974 patients used TNF inhibitors, 803 IL-12/23 inhibitor, and 754 IL-17 inhibitors.
During a median follow-up of 1.3 to 1.4 years, 48.5% of the PsO cohort and 57.3% of the PsA cohort discontinued using their biologic treatment. The persistence rates for the PsO and PsA decreased from 76.6% and 72.7% at year 1 to 53.4% and 49.2% at year 2 to 40.9% and 36.2% at year 3, respectively.
Stratified by biologic, persistence at year 1 was higher for IL-12/23 inhibitor (81.1%) and IL-17 inhibitors (80.6%) than for TNF inhibitors (73.8%) among the PsO cohort. By year 3, a similar pattern was observed with higher persistence of IL-12/23 inhibitor (48.2%) and IL-17 inhibitors (45.1%) than for TNF inhibitors (36.8%). Stratified by individual biologic therapies, however, brodalumab, an IL-17 inhibitor, had the highest persistence at years 2 (76.2%) and 3 (76.2%).
For PsA, persistence at year 1 was highest for Il-17 inhibitors (76.7%) followed by TNF inhibitors (72.3%) and IL-12/23 inhibitor (72.2%). By year 3, IL-17 inhibitors had the highest persistence (41.7%) followed by IL-12/23 inhibitor (38.5%) and TNF inhibitors (35.3%). Stratified by individual biologic therapies, ixekizumab, an IL-17 inhibitor, had the highest persistence at years 2 (69.9%) and 3 (41.9%).
IL-17 inhibitors persistence was higher than TNF inhibitors among the PsO (weighted hazard ratio [HR], 0.78; 95% CI, 0.73-0.83; P <.001) and PsA (HR, 0.70; 95% CI, 0.58-0.85; P <.001) cohorts, IL-12/23 inhibitor had higher persistence than TNF inhibitors among the PsO cohort (HR, 0.76; 95% CI, 0.72-0.80; P <.001), and IL-17 inhibitors had higher persistence than IL-12/23 inhibitor among the PsA cohort (HR, 0.69; 95% CI, 0.55-0.87; P <.001).
Results did not differ in a subgroup analysis which excluded patients with associated inflammatory diseases.
This study may have been limited by using health care reimbursement data as a proxy for drug persistence.
These data indicated to the researchers that IL-17 inhibitors had higher persistence than TNF inhibitors in new biologic agent users with PsO and PsA and higher persistence than IL-12/23 inhibitor among patients with PsA.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Vegas LP, Penso L, Claudepierre P, Sbidian E. Long-term persistence of first-line biologics for patients with psoriasis and psoriatic arthritis in the French Health Insurance Database.JAMA Dermatol. Published online March 23, 2022. doi:10.1001/jamadermatol.2022.0364