Psoriatic Arthritis and Biologic Agent Exposure Predict Drug Survival, Discontinuation in Psoriasis

psoriasis on palm of hand closeup
Psoriasis (Photo By BSIP/UIG Via Getty Images)
The choice of biologic agent therapy for psoriasis may be influenced by previous biologic agent treatment or presence of psoriatic arthritis.

The presence of psoriatic arthritis and a history of exposure to biologic agents predict drug survival or discontinuation in patients with chronic plaque psoriasis treated with either adalimumab, secukinumab, or ustekinumab. This is according to study research published in the British Journal of Dermatology.

The prospective cohort study used patient data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), an ongoing pharmacovigilance registry of patients with psoriasis in the United Kingdom. Patients in this study (median age, 45.0 years) had chronic plaque psoriasis and were either recruited into or switched to a biologic agent cohort group initiating adalimumab (n=5543), secukinumab (n=991), or ustekinumab (n=3118). Previous studies were used to identify a priori predictors for drug survival or discontinuation, and a flexible parametric survival model was fitted for biologic discontinuation due to therapy inefficacy.

Compared with ustekinumab, the adjusted hazard ratio (aHR) for discontinuation of adalimumab was 2.11 (95% CI, 1.76-2.54). In addition, the aHR for discontinuation of secukinumab compared with ustekinumab was 0.67 (95% CI, 0.40-1.11). In year 1, the overall drug survival (survival function) was 0.78 (95% CI, 0.77-0.79) for adalimumab, 0.88 (95% CI, 0.86-0.91) for secukinumab, and 0.88 (95% CI, 0.87-0.89) for ustekinumab.

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The presence of psoriatic arthritis predicted discontinuation in the ustekinumab cohort (aHR, 1.42; 95% CI, 1.12-1.81; P <.05) and survival in the adalimumab (aHR, 0.67; 95% CI, 0.51-0.88; P <.05) and secukinumab (aHR, 0.70; 95% CI, 0.40-1.24) cohorts. In addition, discontinuation was predicted by previous exposure to biologic therapies in the ustekinumab (aHR, 1.54; 95% CI, 1.26-1.89; P <.05) and secukinumab (aHR, 1.49; 95% CI, 0.91-2.45) cohorts as well as survival in the adalimumab cohort (aHR, 0.71; 95% CI, 0.55-0.92; P <.05).

Researchers from this study hope their findings “will help patients make an informed decision to start a biologic therapy based on drug survival outcome.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Yiu ZZN, Mason KJ, Hampton PJ, et al; BADBIR Study Group. Drug survival of adalimumab, ustekinumab, and secukinumab in patients with psoriasis: a prospective cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) [published online March 2, 2020]. Br J Dermatol. doi: 10.1111/bjd.18981