Ustekinumab is associated with a better survival advantage over etanercept and adalimumab in pediatric patients with psoriasis, according to retrospective analysis findings published in the Journal of the European Academy of Dermatology and Venereology.
Researchers obtained the clinical records of 134 children with psoriasis treated with biologics in multiple centers throughout Europe. Children were included if they had received ≥1 injection of etanercept, adalimumab, or ustekinumab. Various demographic data — including age, sex, body mass index, clinical characteristics, and personal and familial medical history — were extracted from the medical records by the dermatologist. Analyses were made to evaluate survival associations between each biologic therapy. The researchers also examined adverse events associated with the choice of biologic therapy.
In the cohort, there were 70, 68, and 46 treatment courses with etanercept, adalimumab, and ustekinumab, respectively. Patients who were younger at the time of treatment initiation were more likely to be treated with adalimumab vs etanercept and ustekinumab (P <.0001), whereas patients who were younger at the time of psoriasis onset were more likely to receive adalimumab and etanercept (P =.03).
Overall drug survival rates were higher in patients who were treated with ustekinumab (P <.0001), a finding that was consistent across all treatment and all psoriasis types. Ustekinumab was associated with greater survival in plaque-type psoriasis (P =.0003), patients naïve to biologic agents (P =.0007), and non-naïve patients (P =.007).
A total of 7  serious adverse events were reported, including severe infections (n=3), significant weight gain (n=2), psoriasis flare (n=1), and malaise (n =1). Treatment discontinuation occurred in 3 children.
Limitations of the analysis included the retrospective and observational nature, as well as the inclusion of only a small number of patients.
According to the researchers, the observed adverse events were not considered rare and “were similar to those found in adults using biological agents, suggesting that the same levels of vigilance and precautions used for the prevention of these adverse events in adults receiving biological agents should also be applied to children on biological therapy.”
Phan C, Beauchet A, Burztejn AC, et al; Groupe de Recherche de la Société Française de Dermatologie Pédiatrique; Groupe de Recherche sur le Psoriasis de la Société Française de Dermatologie. Biological treatments for paediatric psoriasis: a retrospective observational study on biological drug survival in daily practice in childhood psoriasis [published online March 18, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15579