Differential Drug Survival of Biologic Therapies for the Treatment of Psoriasis: A Prospective Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

TY - JOUR

T1 - Differential Drug Survival of Biologic Therapies for the Treatment of Psoriasis

T2 - A Prospective Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

AU - Warren, Richard B

AU - Smith, Catherine H

AU - Yiu, Zenas Z N

AU - Ashcroft, Darren M

AU - Barker, Jonathan N W N

AU - Burden, A David

AU - Lunt, Mark

AU - McElhone, Kathleen

AU - Ormerod, Anthony D

AU - Owen, Caroline M

AU - Reynolds, Nick J

AU - Griffiths, Christopher E M

AU - BADBIR Study Group

PY - 2015/11

Y1 - 2015/11

N2 - Drug survival reflects a drug's effectiveness, safety, and tolerability. We assessed the drug survival of biologics used to treat psoriasis in a prospective national pharmacovigilance cohort (British Association of Dermatologists Biologic Interventions Register (BADBIR)). The survival rates of the first course of biologics for 3,523 biologic-naive patients with chronic plaque psoriasis were compared using survival analysis techniques and predictors of discontinuation analyzed using a multivariate Cox proportional hazards model. Data for patients on adalimumab (n=1,879), etanercept (n=1,098), infliximab (n=96), and ustekinumab (n=450) were available. The overall survival rate in the first year was 77%, falling to 53% in the third year. Multivariate analysis showed that female gender (hazard ratio (HR) 1.22; 95% confidence interval (CI): 1.09-1.37), being a current smoker (HR 1.19; 95% CI: 1.03-1.38), and a higher baseline dermatology life quality index (HR 1.01; 95% CI: 1.00-1.02) were predictors of discontinuation. Presence of psoriatic arthritis (HR 0.82; 95% CI: 0.71-0.96) was a predictor for drug survival. As compared with adalimumab, patients on etanercept (HR 1.63; 95% CI: 1.45-1.84) or infliximab (HR 1.56; 95% CI: 1.16-2.09) were more likely to discontinue therapy, whereas patients on ustekinumab were more likely to persist (HR 0.48; 95% CI: 0.37-0.62). After accounting for relevant covariates, ustekinumab had the highest first-course drug survival. The results of this study will aid clinical decision making when choosing biologic therapy for psoriasis patients.

AB - Drug survival reflects a drug's effectiveness, safety, and tolerability. We assessed the drug survival of biologics used to treat psoriasis in a prospective national pharmacovigilance cohort (British Association of Dermatologists Biologic Interventions Register (BADBIR)). The survival rates of the first course of biologics for 3,523 biologic-naive patients with chronic plaque psoriasis were compared using survival analysis techniques and predictors of discontinuation analyzed using a multivariate Cox proportional hazards model. Data for patients on adalimumab (n=1,879), etanercept (n=1,098), infliximab (n=96), and ustekinumab (n=450) were available. The overall survival rate in the first year was 77%, falling to 53% in the third year. Multivariate analysis showed that female gender (hazard ratio (HR) 1.22; 95% confidence interval (CI): 1.09-1.37), being a current smoker (HR 1.19; 95% CI: 1.03-1.38), and a higher baseline dermatology life quality index (HR 1.01; 95% CI: 1.00-1.02) were predictors of discontinuation. Presence of psoriatic arthritis (HR 0.82; 95% CI: 0.71-0.96) was a predictor for drug survival. As compared with adalimumab, patients on etanercept (HR 1.63; 95% CI: 1.45-1.84) or infliximab (HR 1.56; 95% CI: 1.16-2.09) were more likely to discontinue therapy, whereas patients on ustekinumab were more likely to persist (HR 0.48; 95% CI: 0.37-0.62). After accounting for relevant covariates, ustekinumab had the highest first-course drug survival. The results of this study will aid clinical decision making when choosing biologic therapy for psoriasis patients.

KW - Adalimumab

KW - Adult

KW - Biological Products

KW - Biological Therapy

KW - Cohort Studies

KW - Dermatology

KW - Dose-Response Relationship, Drug

KW - Drug Administration Schedule

KW - Etanercept

KW - Female

KW - Humans

KW - Infliximab

KW - Kaplan-Meier Estimate

KW - Male

KW - Maximum Tolerated Dose

KW - Middle Aged

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Psoriasis

KW - Registries

KW - Societies, Medical

KW - Ustekinumab

U2 - 10.1038/jid.2015.208

DO - 10.1038/jid.2015.208

M3 - Article

C2 - 26053050

SN - 0022-202X

VL - 135

SP - 2632

EP - 2640

JO - Journal of Investigative Dermatology

JF - Journal of Investigative Dermatology

IS - 11

ER -