Differential Drug Survival of Second-Line Biologic Therapies In Patients with Psoriasis: Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

Ireny Y K Iskandar, Richard B Warren, Mark Lunt, Kayleigh J Mason, Ian Evans, Kathleen McElhone, Catherine H Smith, Nick J Reynolds, Darren M Ashcroft, Christopher E M Griffiths, BADBIR Study Group

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Abstract

Little is known about the drug survival of second-line biologic therapies for psoriasis in routine clinical practice. We assessed drug survival of second-line biologic therapies and estimated the risk of recurrent discontinuation due to adverse events (AEs) or ineffectiveness in psoriasis patients who had failed a first biologic and switched to a second in a large, multi-centre pharmacovigilance registry (n=1239; adalimumab,538; etanercept,104; ustekinumab,597). The overall drug survival rate in the first year after switching was 77% (95% confidence interval (CI): 74%-79%), falling to 58% (55%-61%) in the third year. Female gender, multiple comorbidities, concomitant therapy with ciclosporin, and a high Psoriasis Area and Severity Index at switching onto the second-line biologic were predictors of overall discontinuation (multivariable Cox proportional hazard model). Compared to adalimumab, patients receiving etanercept were more likely to discontinue therapy (hazard ratio 1.95; 95% CI:1.46-2.59), whereas patients on ustekinumab were more likely to persist (0.46;0.37-0.58). Discontinuation of the first biologic due to AEs was associated with an increased rate of second drug discontinuation due to AEs (2.48;1.48-4.16). In conclusion, drug survival rates differed amongst biologics and decreased over time; second-line discontinuation due to AEs was more common among those who discontinued first-line treatment for this reason. The results of this study should support clinical decision making when choosing second-line biologic therapy for patients with psoriasis.

Original languageEnglish
Pages (from-to)775-784
Number of pages9
JournalThe Journal of Investigative Dermatology
Volume138
Early online date6 Dec 2017
DOIs
Publication statusPublished - 2018

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