Journal Article

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)

Yiu, Zenas Z.N., Griffiths, Christopher E.M., Ormerod, Anthony D., Barker, Jonathan N.W.N., Lunt, Mark, Reynolds, Nick J., McElhone, Kathleen, Owen, Caroline M., Warren, Richard B., Ashcroft, Darren M., Burden, A. David, Smith, Catherine H.

2015

Overview

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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adalimumab - administration & dosage / Adult / Biological Products - administration & dosage / Biological Products - pharmacokinetics / Biological Therapy - methods / Cohort Studies / Dermatology / Dose-Response Relationship, Drug / Drug Administration Schedule / Etanercept - administration & dosage / Etanercept - pharmacokinetics / Female / Humans / Infliximab - administration & dosage / Infliximab - pharmacokinetics / Kaplan-Meier Estimate / Male / Maximum Tolerated Dose / Middle Aged / Proportional Hazards Models / Prospective Studies / Psoriasis - diagnosis / Psoriasis - drug therapy / Registries / Societies, Medical / Ustekinumab - administration & dosage / Ustekinumab - pharmacokinetics