Drug Survival of Adalimumab, Ustekinumab, and Secukinumab in Patients with Psoriasis: a Prospective Cohort Study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR).
Real-world biologic drug survival is an important proxy measure for effectiveness. Predictors of drug survival may help patients with psoriasis choose between biologic therapies.1. To assess the relative drug survival of adalimumab, ustekinumab and secukinumab in patients with psoriasis; 2. To investigate for predictors for biologic drug survival.A prospective cohort study was performed in the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) between November 2007 and August 2019. We performed survival analysis and fitted a flexible parametric survival model for biologic discontinuation due to ineffectiveness.5,542 starting on adalimumab (57.4%); 991, secukinumab (10.3%); and 3118 on ustekinumab (32.3%) were included. Overall drug survival of adalimumab, secukinumab and ustekinumab was 0.78 (95% CI 0.77-0.79), 0.88 (0.86-0.91) and 0.88 (0.87-0.89) in Year 1 respectively. The adjusted hazard ratios (adjHR) for discontinuation of adalimumab and secukinumab compared with ustekinumab were 2.11 (95% CI 1.76-2.54) and 0.67 (95% CI 0.40-1.11) respectively. The presence of psoriatic arthritis predicted for survival in the adalimumab and secukinumab cohorts (adjHR 0.67 (0.51-0.88); 0.70 (0.40-1.24) respectively) but for discontinuation in the ustekinumab cohort (adjHR 1.42 [1.12-1.81]). Previous exposure to biologic therapies predicted for discontinuation in the ustekinumab and secukinumab cohorts (adjHR 1.54 (1.26-1.89); 1.49 (0.91-2.45) respectively) and for survival in the adalimumab cohort (adjHR 0.71 (0.55-0.92)).Secukinumab and ustekinumab have similar sustained drug survival, whilst adalimumab has a lower drug survival in patients with psoriasis. Psoriatic arthritis and previous biologic experience were predictors with differential effects between the biologic therapies.