Psoriasis Treatment With Biologics Often Requires Multiple Courses, Treatment Changes

Real-world data suggests that biologic therapy in patients with psoriasis is less effective than initially predicted, particularly in a non-selected population, with long-term disease control usually requiring several courses of the same biologic agent or of different agents, according to the results of a nationwide population-based cohort study published in the British Journal of Dermatology.

The investigators sought to evaluate the long-term persistence of biologic agents used in the treatment of psoriasis in a real-world setting.

Adult patients with psoriasis who had been registered in the French national health insurance database (SNIIRAM) from 2008 to 2016 were eligible for study inclusion. In this analysis, psoriasis was defined as the filling of ≥2 prescriptions for topical formulations of vitamin D derivative within a 2-year period. The final analysis set comprised biologic-naïve individuals — individuals who had filled an initial prescription for etanercept, infliximab, adalimumab, or ustekinumab after 2 years without using any biologic agent during the study period. Persistence of treatment with a biologic agent was defined as the amount of time between drug initiation and discontinuation.

Of the patients assessed, 16,545 of 874,549 with psoriasis were deemed biologic-naïve. Mean participant age was 48.6±13.5; 57.3% were men. The mean follow-up time was 3.6±2.4 years. A total of 9988 treatment discontinuations were recorded.

Per Kaplan-Meier survival analysis, persistence rates of 61.9%, 33.3%, and 22.6% were reported for the first, third, and fifth years of treatment, respectively. Of the biologics evaluated, ustekinumab was associated with the highest persistence rate. This finding should be interpreted with caution, however, because of the differences in administration of the various biologic agents analyzed. In fact, approximately 85% of patients who discontinued their initial biologic agent resumed systemic treatment with another agent in the following year (which was a biologic in 85% of patients).

The investigators concluded that biologic therapy seems to be highly effective for the induction of short-term remission in a selected trial population of patients with psoriasis. They emphasize the need to conduct “therapeutic strategy studies,” noting the current unmet needs that exist and the requirement of guidelines for maintenance treatment of psoriasis. These include adjustment of therapy in patients with stable, low disease activity; add-on therapies or switches in therapy for patients who fail to respond to systemic treatment; and long-term safety data.

Reference

Sbidian E, Mezzarobba M, Weill A, Coste J, Rudant J. Persistence of treatment with biologics for patients with psoriasis: a real-world analysis of 16,545 biologic-naïve patients from the French national health insurance database (SNIIRAM) [published online May 23, 2018]. Br J Dermatol. doi:10.1111/bjd.16809