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)

TY - JOUR

T1 - Differential Drug Survival of Second-Line Biologic Therapies In Patients with Psoriasis

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

AU - Iskandar, Ireny Y K

AU - Warren, Richard B

AU - Lunt, Mark

AU - Mason, Kayleigh J

AU - Evans, Ian

AU - McElhone, Kathleen

AU - Smith, Catherine

AU - Reynolds, Nick J

AU - Ashcroft, Darren M

AU - Griffiths, Christopher E M

AU - BADBIR Study Group

N1 - Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2017/10/25

Y1 - 2017/10/25

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.jid.2017.09.044

DO - 10.1016/j.jid.2017.09.044

M3 - Article

C2 - 29080680

SN - 0022-202X

JO - Journal of Investigative Dermatology

JF - Journal of Investigative Dermatology

ER -