Drug survival of biological therapy is showing class effect: updated results from Slovenian National Registry of psoriasis

BackgroundDrug survival is an important measure of successful treatment of patients with chronic diseases such as psoriasis. Therefore, the objective was to calculate drug survival and examine safety profile of biologics and immunomodulators (adalimumab, apremilast, etanercept, ixekizumab, infliximab, secukinumab, and ustekinumab) from the Slovenian National Registry of patients with moderate-to-severe psoriasis. MethodsData about the patients with moderate-to-severe plaque psoriasis treated with biologics were collected from 2005 until July 2018. Kaplan-Meier survival curves and Cox regression were used to calculate drug survival, where ustekinumab was selected as a reference. ResultsOverall, 1,606 patients were analyzed within 2,241 treatment episodes; adalimumab N=831, apremilast N=94, etanercept N=101, ixekizumab N=98, infliximab N=164, secukinumab N=340, and ustekinumab N=613, respectively. Loss of efficacy was the most frequent reason for treatment discontinuation (contributing to 66.1% of all discontinuations). Ustekinumab was associated with the highest drug survival, meanwhile apremilast was the drug with the lowest survival rate compared to all others. Both IL-17 inhibitors, secukinumab and ixekizumab, showed similar survival rate. ConclusionsUstekinumab was associated with the highest drug survival and most favorable safety profile compared to other biologics. Drug survival rates can be associated with the class effect of biological targets. Highest survival rate was observed for IL-12/23 inhibitor, followed by IL-17 and TNF-alpha inhibitors, and last by an immunomodulator such as apremilast. Adverse events occurred most frequently with TNF-alpha inhibitors.