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Patients stayed longer with guselkumab (Tremfya) for psoriasis treatment than any other biologic drug, while adalimumab (Humira) was dropped the quickest, British registry data indicated.

With ustekinumab (Stelara) chosen arbitrarily as the reference, the multivariable-adjusted hazard ratio for discontinuation in 1 year was 0.13 for guselkumab (95% CI 0.03-0.56) versus 2.37 (95% CI 2.03-2.76) for adalimumab, according to Zenas Yiu, PhD, of Salford Royal NHS Foundation Trust in England, and colleagues.

Other biologics approved for psoriasis and included in the analysis were secukinumab (Cosentyx) and ixekizumab (Taltz). The former showed moderately poorer longevity compared with ustekinumab (but better than adalimumab) while ixekizumab was intermediate between ustekinumab and guselkumab, they reported in .

While the contrasts aren't a direct measure of comparative effectiveness, they are certainly suggestive of it. In any case, the study's main goal was to identify factors correlated with drug longevity (or "survival" as the authors called it), and it was successful in that respect.

Patients who had arthritic as well as skin symptoms, or had nail involvement, were significantly more likely to discontinue, in both cases by about 20%. Nonwhite race/ethnicity was also significantly associated with early stoppage of treatment. The data also showed that ineffectiveness was cited more commonly than side effects as the principal reason for discontinuation, by ratios of 2:1 to 4:1 for all the drugs except guselkumab. For the latter, discontinuation rates were about the same for ineffectiveness and adverse events.

"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," Yiu and colleagues concluded.

Findings from the study were also presented at the annual meeting of the British Association of Dermatologists.

Data for the study came from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), covering some 16,000 biologic treatment courses delivered from 2007 to 2021. About 6,600 courses involved adalimumab, 5,400 were with ustekinumab, 2,700 were secukinumab, and about 700 each involved guselkumab and ixekizumab. The differences mainly reflected the times that these agents reached the market for patients with psoriatic conditions.

Median duration of follow-up ranged from 1.1 years for guselkumab to 2.7 years for ustekinumab. Kaplan-Meier curves showed that about 20% of patients taking adalimumab had stopped it within the first year, compared to 6% of those using guselkumab. Longevity of the other three agents fell in between. Notably, though, rates of discontinuation eased somewhat during the second year for adalimumab, guselkumab, and ustekinumab, whereas they continued to occur at the first-year rate for secukinumab and ixekizumab, such that 25% of patients on those drugs as well as adalimumab had stopped them by the end of year 2.

The authors also highlighted that patients who had previously used ustekinumab and switched to another biologic tended not to stay with them for long, except for guselkumab. In addition, female sex and comorbidities, including chronic obstructive pulmonary disease and diabetes, appeared predictive of early discontinuation for ineffectiveness. And patients who had taken methotrexate and/or cyclosporine were also more likely to discontinue biologics for ineffectiveness.

Study limitations included the potential for recording errors in BADBIR, possible assessment lapses during the COVID-19 pandemic when many patients were evaluated remotely, and the relatively severe disease that patients had on average. Because the registry only covers patients in the U.K. and Ireland, the findings may not be generalizable to populations with different ethnic-racial mixes.

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