Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study
Por:
Torres, T, Puig, L, Vender, R, Lynde, C, Piaserico, S, Carrascosa, JM, Gisondi, P, Dauden, E, Conrad, C, Mendes-Bastos, P, Ferreira, P, Leite, L, Lu, JSD, Valerio, J, Bruni, M, Messina, F, Nidegger, A, Llamas-Velasco, M, del Alcazar, E, Mufti, A, White, K, Caldarola, G, Teixeira, L, Romanelli, P, Desai, K, Gkalpakiotis, S, Romanelli, M, Yeung, JN, Nogueira, M and Chiricozzi, A
Publicada:
1 jul 2021
Ahead of Print:
1 mar 2021
Resumen:
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.
Filiaciones:
Torres, T:
Ctr Hosp Univ Porto, Dept Dermatol, Porto, Portugal
Univ Porto, Inst Ciencias Biomed Abel Salazar, Porto, Portugal
Puig, L:
Hosp Santa Creu & Sant Pau, Dept Dermatol, Barcelona, Spain
Vender, R:
McMaster Univ, Hamilton, ON, Canada
Lynde, C:
Lynde Inst Dermatol, Markham, ON, Canada
Piaserico, S:
Univ Padua, Dept Med, Dermatol Unit, I-35128 Padua, Italy
:
Autonomous Univ Barcelona UAB, Germans Trias & Pujol Univ Hosp HUGTP, Dept Dermatol, Badalona, Spain
Gisondi, P:
Univ Verona, Sect Dermatol & Venereol, Dept Med, I-37126 Verona, Italy
Dauden, E:
Inst Invest Sanitaria La Princesa IISIP, Hosp Univ Princesa, Dermatol Dept, Madrid, Spain
Conrad, C:
Univ Lausanne, Lausanne Univ Hosp CHUV, Dept Dermatol, Lausanne, Switzerland
Mendes-Bastos, P:
Hosp CUF Descobertas, Lisbon, Portugal
Ferreira, P:
Hosp CUF Descobertas, Lisbon, Portugal
Leite, L:
Clin Med Belem, Lisbon, Portugal
Lu, JSD:
Michael G DeGroote Sch Med, Fac Med, Hamilton, ON, Canada
Valerio, J:
Clin Med Belem, Lisbon, Portugal
Bruni, M:
Univ Verona, Sect Dermatol & Venereol, Dept Med, I-37126 Verona, Italy
Messina, F:
Univ Padua, Dept Med, Dermatol Unit, I-35128 Padua, Italy
Nidegger, A:
Univ Lausanne, Lausanne Univ Hosp CHUV, Dept Dermatol, Lausanne, Switzerland
Llamas-Velasco, M:
Inst Invest Sanitaria La Princesa IISIP, Hosp Univ Princesa, Dermatol Dept, Madrid, Spain
del Alcazar, E:
Autonomous Univ Barcelona UAB, Germans Trias & Pujol Univ Hosp HUGTP, Dept Dermatol, Badalona, Spain
Mufti, A:
Univ Toronto, Prob Med Res, Dept Med, Div Dermatol, Waterloo, ON, Canada
White, K:
Lynde Inst Dermatol, Markham, ON, Canada
Caldarola, G:
Fdn Policlinico Univ A Gemelli IRCCS, Rome, Italy
Univ Cattolica Sacro Cuore, Largo Agostino Gemelli 8, I-00168 Rome, Italy
Teixeira, L:
Univ Porto ICBAS UP, Inst Biomed Sci Abel Salazar, Ctr Hlth Technol & Serv Res CINTESIS, Porto, Portugal
Romanelli, P:
Univ Miami, Miller Sch Med, Dr Phillip Frost Dept Dermatol & Cutaneous Surg, Miami, FL 33136 USA
Desai, K:
Univ Miami, Miller Sch Med, Dr Phillip Frost Dept Dermatol & Cutaneous Surg, Miami, FL 33136 USA
Gkalpakiotis, S:
Charles Univ Prague, Fac Med 3, Dept Dermatovenereol, Prague, Czech Republic
Kralovske Vinohrady Univ Hosp, Prague, Czech Republic
Romanelli, M:
Univ Pisa, Dept Dermatol, Pisa, Italy
Yeung, JN:
Univ Toronto, Prob Med Res, Dept Med, Div Dermatol, Waterloo, ON, Canada
Nogueira, M:
Ctr Hosp Univ Porto, Dept Dermatol, Porto, Portugal
Chiricozzi, A:
Fdn Policlinico Univ A Gemelli IRCCS, Rome, Italy
Univ Cattolica Sacro Cuore, Largo Agostino Gemelli 8, I-00168 Rome, Italy
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