A recent study published in JAMA Dermatology examined drug survival in common psoriasis biologic medications as proxies for safety and effectiveness, naming guselkumab and ustekinumab as the biologics with the highest survival.
“Network meta-analyses of randomized clinical trials in psoriasis have suggested that newer biologics that target IL-23, p19, and IL-17 generally have a higher treatment efficacy compared with the older biologics that target TNF-α and ustekinumab,” Zenas Z. N. Yiu, PhD, a clinical lecturer at the National Institute of Health Research, University of Manchester, UK, and colleagues wrote. “However, drug response and safety of treatment with biologics for psoriasis in clinical trials do not fully reflect the routine clinical setting. Drug survival is a proxy measure for the effectiveness, safety, adherence, and tolerability of a medicine. Effect modification describes whether the effect of a treatment differs in groups of patients with different characteristics, in contrast to confounding, which represents a distortion of the true treatment effect by another variable.”
The researchers performed a cohort study using the British Association of Dermatologists Biologics and Immunomodulators registry, which has tracked psoriasis treatment at 165 different clinics in the U.K. and the Republic of Ireland since 2007. They examined 16,122 courses of treatment, determining which biologics showed the best survival for both effectiveness and safety and which patient factors influenced drug survival. Yiu and colleagues focused their analysis on the drugs adalimumab, ustekinumab, secukinumab, guselkumab, and ixekizumab.
Adalimumab was the most used treatment, having been initiated in 41% of courses of therapy (n = 6,607). The next most common was ustekinumab (n = 5,405; 33.5%), followed by secukinumab (n = 2,677; 16.6%), guselkumab (n = 730; 4.5%), and ixekizumab (n = 703; 4.4%).
When Yiu and colleagues evaluated drug survival using effectiveness measures, they reported that guselkumab had the highest crude survival function at the 1-year mark (0.94; 95% CI, 0.92-0.96), followed by ustekinumab (0.89; 95% CI, 0.88-0.89), secukinumab (0.86; 95% CI, 0.85-0.87), ixekizumab (0.86; 95% CI, 0.83-0.89), and adalimumab (0.81; 95% CI, 0.8-0.82).
The adjusted survival curves were examined using a multivariable model, and guselkumab had a higher drug survival (adjusted HR = 0.13; 95% CI, 0.03-0.56) compared with ustekinumab, whereas adalimumab (adjusted HR = 2.37; 95% CI, 2.03-2.76) had a lower survival compared with ustekinumab.
In terms of safety, the researchers reported that guselkumab had the highest crude survival at 1 year (0.96; 95% CI, 0.94-0.98), followed by ustekinumab (0.94; 95% CI, 0.94-0.95), secukinumab (0.94; 95% CI, 0.92-0.94), ixekizumab (0.92; 95% CI, 0.89-0.94), and adalimumab (0.91; 95% CI, 0.9-0.91). Three of the drugs had similar adjusted curves for safety—ustekinumab, secukinumab, and guselkumab—whereas ixekizumab (adjusted HR = 1.52; 95% CI, 1.13-2.03) and adalimumab (adjusted HR = 1.66; 95% CI, 1.46-1.89) both had lower survival than ustekinumab.
Yiu and colleagues identified a number of factors associated with effectiveness-specific drug survival. These were ethnicity, psoriatic arthritis, nail involvement, and previous exposure to biologics.
“This information on longer-term treatment effects, safety, and tolerability, along with other factors, such as background comorbidities and patient values, may help patients and their clinicians make an informed decision to initiate treatment with a particular biologic therapy,” the researchers concluded.
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Disclosures: Some authors declared financial ties to drugmakers. See full study for details.
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