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Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study

  • Original Research Article
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American Journal of Clinical Dermatology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 27 October 2021

A Letter to the Editor to this article was published on 27 October 2021

A Letter to the Editor to this article was published on 27 October 2021

A Letter to the Editor to this article was published on 22 June 2021

Abstract

Background

Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients’ adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis—ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab—and to identify clinical predictors that can influence the drug survival of these drugs.

Methods

This retrospective multicentric cohort study from 16 dermatology centers in Portugal, Spain, Italy, Switzerland, Czech Republic, Canada, and the United States included patients that started IL-12/23, IL-17 (IL-17A and IL-17R) and IL-23 inhibitors for the treatment of psoriasis between January 1, 2012 and December 31, 2019. Survival analysis was performed using a Kaplan-Meier estimator, to obtain descriptive survival curves, and proportional hazard Cox regression models.

Results

A total of 3312 treatment courses (total patients: 3145) were included in the study; 1118 (33.8%) with an IL-12/23 inhibitor (ustekinumab), 1678 (50.7%) with an IL-17 inhibitor [911 (27.5%) on secukinumab, 651 (19.7%) on ixekizumab, 116 (3.5%) on brodalumab], and 516 (15.5%) with an IL-23 inhibitor [398 (12.0%) on guselkumab, 118 (3.5%) on risankizumab]. At 18 months, the cumulative probability of survival was 96.4% for risankizumab, 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab, and 79.9% for secukinumab. Using ustekinumab as reference, drug survival of guselkumab was higher (HR 0.609; 95% CI 0.418–0.887) and that of secukinumab was lower (HR 1.490; 95% CI 1.257–1.766). In the final multivariable model, secukinumab, female sex, higher BMI, and prior exposure to biologic agents significantly increased the risk of drug discontinuation, whereas risankizumab was protective.

Conclusion

In this multinational cohort with 8439 patient-years of follow-up, the cumulative probability of drug survival for all drugs was >79% at 18 months. Prescribed biologic, female sex, higher BMI, and previous exposure to biologic agents were predictors of drug discontinuation. Drug survival of guselkumab and risankizumab was higher than that of ustekinumab, and secukinumab was lower.

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Author information

Authors and Affiliations

  1. Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal

    Tiago Torres & Miguel Nogueira

  2. Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal

    Tiago Torres

  3. Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Luis Puig

  4. McMaster University, Hamilton, Ontario, Canada

    Ron Vender

  5. Lynde Institute for Dermatology, Markham, Ontario, Canada

    Charles Lynde & Kyra White

  6. Dermatology Unit, Department of Medicine, University of Padua, 35128, Padua, Italy

    Stefano Piaserico & F. Messina

  7. Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain

    Jose M. Carrascosa & E. del Alcazar

  8. Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126, Verona, Italy

    Paolo Gisondi & M. Bruni

  9. Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain

    Esteban Daudén & M. Llamas-Velasco

  10. Department of Dermatology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland

    Curdin Conrad & A. Nidegger

  11. Hospital CUF Descobertas, Lisbon, Portugal

    Pedro Mendes-Bastos & Paulo Ferreira

  12. Clínica Médica Belém, Lisbon, Portugal

    Luiz Leite & J. Valerio

  13. Michael G. DeGroote School of Medicine, Faculty of Medicine, Hamilton, Ontario, Canada

    Justin D. Lu

  14. Division of Dermatology, Department of Medicine, University of Toronto, Probity Medical Research, Waterloo, Ontario, Canada

    A. Mufti & Jensen Yeung

  15. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    G. Caldarola & Andrea Chiricozzi

  16. Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy

    G. Caldarola & Andrea Chiricozzi

  17. Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS.UP), Porto, Portugal

    Laetitia Teixeira

  18. Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA

    Paolo Romanelli & K. Desai

  19. Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic

    Spyridon Gkalpakiotis

  20. Department of Dermatology, University of Pisa, Pisa, Italy

    Marco Romanelli

Authors
  1. Tiago Torres
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  2. Luis Puig
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  3. Ron Vender
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  4. Charles Lynde
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  5. Stefano Piaserico
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  6. Jose M. Carrascosa
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  7. Paolo Gisondi
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  8. Esteban Daudén
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  9. Curdin Conrad
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  11. Paulo Ferreira
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  15. M. Bruni
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  16. F. Messina
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  17. A. Nidegger
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  18. M. Llamas-Velasco
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  19. E. del Alcazar
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  20. A. Mufti
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  21. Kyra White
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  22. G. Caldarola
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  23. Laetitia Teixeira
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  26. Spyridon Gkalpakiotis
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  27. Marco Romanelli
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  28. Jensen Yeung
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  29. Miguel Nogueira
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  30. Andrea Chiricozzi
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Corresponding author

Correspondence to Tiago Torres.

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Funding

None.

Conflicts of interest

T. Torres has received honoraria for acting as a consultant and/or as a speaker from AbbVie, Almirall, Amgen, Arena Pharmaceuticals, Biocad, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Leo Pharma, MSD, Novartis, Pfizer, Samsung-Bioepis, Sandoz, and Sanofi. L. Puig has received honoraria for acting as a consultant and/or as a speaker from AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, Leo Pharma, Lilly, Merck-Serono, MSD, Novartis, Pfizer, Regeneron, Roche, and Sandoz. R. Vender has received grants/research support and acted as speaker/consultant from Abbvie, Amgen, Bausch-Health, Celgene, Centocor, Dermira, Dermavant, Galderma, GSK, Leo, Lilly, Takeda, Novartis, Merck, Mylan, Palladin, Pfizer, Regeneron, Sandoz, Sanofi, Sentrex, Sun, and UCB. C. Lynde has been a speaker, consultant and/or private investigator for AbbVie, Allergan, Amgen, Aralez, Arcutis, Bausch Health, Bayer, Boehringer Ingelheim, Celgene, Cipher, Dermavant, Eli Lilly, Galderma, Genentech, Glenmark, GSK, Innovaderm, Janssen, Kyowa, L’Oreal, LeoPharma, Merck, Medexus, Mylan, Novartis, Pediapharm, Pfizer, Procter and Gamble, Roche, Sandoz, Sanofi Adventis, Sanofi Genzyme, Stiefel, TEVA, and Valeant. S. Piaserico has been a consultant and/or speaker for Abbvie, Almirall, Amgen, Janssen, LEO Pharma, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Sandoz, and UCB. J.M. Carrascosa has participated as investigator and/or advisor and/or invited speaker for Abbvie, Janssen, Novartis, Lilly, Leo-Pharma, Almirall, Amgen, Sandoz, Mylan, and Pfizer. P. Gisondi has received honoraria for acting as a consultant and/or as a speaker from AbbVie, Almirall, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Leo Pharma, MSD, Novartis, Pfizer, Sandoz, Sanofi, and UCB. E. Daudén has the following conflict of interests: Advisory Board member, consultant, grants, research support, participation in clinical trials, honorarium for speaking, research support, with the following pharmaceutical companies: Abbvie/Abbott, Almirall, Amgen, Janssen-Cilag, Leo Pharma, Novartis, Pfizer, MSD-Schering-Plough, Celgene, Lilly, and UCB. C. Conrad has served as scientific adviser and/or clinical study investigator and/or paid speaker for AbbVie, Actelion, Amgen, BMS, Celgene, Galderma, Incyte, Janssen, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Samsung, and UCB. P. Mendes-Bastos has received honoraria for acting as a consultant and/or as a speaker from AbbVie, Pfizer, Janssen, LEO Pharma, Novartis, Sanofi, Teva, Bayer, and L’Oreal. P. Ferreira has received honoraria for acting as a consultant and/or as a speaker from AbbVie, Janssen, LEO-Pharma, Eli-Lilly, Novartis, and Pfizer. L. Leite: none. J.D. Lu: none. J. Valerio: none. M. Bruni: none. F. Messina: none. A. Nidegger: none. M. Llamas-Velasco: none. E. del Alcazar has participated as SI and/or invited speaker for Abbvie, Janssen, Novartis, Lilly, Leo-Pharma, Almirall, Amgen, UCB, and Sanofi. A. Mufti: none. K. White: none. G. Caldarola: none. L. Teixeira: none. P. Romanelli: none. K. Desai: none. S. Gkalpakiotis has received honoraria for acting as a consultant and/or as a speaker from Abbvie, Amgen, Eli Lilly, Novartis, Leo Pharma, and Janssen-Cilag. M. Romanelli has been an advisory board member and consultant and has received fees and speaker’s honoraria or has participated in clinical trials for Abbvie, Abiogen, Almirall, Lilly, Mundipharma, Novartis, Leo Pharma, Smith & Nephew, Urgo Medical, Hartman, and Sanofi. J. Yeung has been a speaker, consultant, and investigator for AbbVie, Allergan, Amgen, Astellas, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, GSK, Janssen, Leo, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Takeda, UCB, Valeant, and Xenon. M. Nogueira has received honoraria for acting as a speaker from Leo Pharma. A. Chiricozzi has served as advisory board member and consultant and has received fees and speaker's honoraria or has participated in clinical trials for AbbVie, Almirall, Biogen, Fresenius Kabi, Leo Pharma, Lilly, Janssen, Novartis, Sanofi Genzyme, and UCB Pharma.

Ethics approval

The present study was conducted in accordance with the Declaration of Helsinki initially published in 1964 on Ethical Principles for Medical Research Involving Human Subjects and after approval by the local ethical committees.

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Raw data are available on request from the authors.

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Author contributions

TT and AC contributed to the study concept and design. TT, LP, LT and AC conducted the statistical analyses on the data. All authors participated in data collection, interpreted the data, provided critical feedback on the manuscript, approved the final manuscript for submission, and were accountable for the accuracy and integrity of the article.

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Torres, T., Puig, L., Vender, R. et al. Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study. Am J Clin Dermatol 22, 567–579 (2021). https://doi.org/10.1007/s40257-021-00598-4

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