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Differential Drug Survival of Second-Line Biologic Therapies in Patients with Psoriasis: Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR).

Iskandar, Ireny Y.K.; Warren, Richard B.; Lunt, Mark; Mason, Kayleigh J.; Evans, Ian; McElhone, Kathleen; Smith, Catherine H.; Reynolds, Nick J.; Ashcroft, Darren M.; Griffiths, Christopher E.M.

Differential Drug Survival of Second-Line Biologic Therapies in Patients with Psoriasis: Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR). Thumbnail


Authors

Ireny Y.K. Iskandar

Richard B. Warren

Mark Lunt

Ian Evans

Kathleen McElhone

Catherine H. Smith

Nick J. Reynolds

Darren M. Ashcroft

Christopher E.M. Griffiths



Abstract

Little is known about the drug survival of second-line biologic therapies for psoriasis in routine clinical practice. We assessed drug survival of second-line biologic therapies and estimated the risk of recurrent discontinuation due to adverse events or ineffectiveness in patients with psoriasis who had failed a first biologic therapy and switched to a second in a large, multicenter pharmacovigilance registry (n = 1,239; adalimumab, n = 538; etanercept, n = 104; ustekinumab, n = 597). The overall drug survival rate in the first year after switching was 77% (95% confidence interval = 74-79%), falling to 58% (55-61%) in the third year. Female sex, multiple comorbidities, concomitant therapy with cyclosporine, and a high Psoriasis Area and Severity Index at switching to the second-line biologic therapy were predictors of overall discontinuation (multivariable Cox proportional hazard model). Compared to adalimumab, patients receiving etanercept were more likely to discontinue therapy (hazard ratio = 1.87, 95% confidence interval = 1.24-2.83), whereas patients receiving ustekinumab were more likely to persist (hazard ratio = 0.46; 95% confidence interval = 0.33-0.64). Discontinuation of the first biologic therapy because of adverse events was associated with an increased rate of second drug discontinuation because of adverse events (hazard ratio = 2.55; 95% confidence interval = 1.50-4.32). In conclusion, drug survival rates differed among biologic therapies and decreased over time; second-line discontinuation because of adverse events was more common among those who discontinued first-line treatment for this reason. The results of this study should support clinical decision making when choosing second-line biologic therapy for patients with psoriasis.

Journal Article Type Article
Acceptance Date Sep 22, 2017
Online Publication Date Oct 25, 2017
Publication Date 2018-04
Publicly Available Date Mar 29, 2024
Journal Journal of Investigative Dermatology
Print ISSN 0022-202X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 138
Issue 4
Pages 775 - 784
DOI https://doi.org/10.1016/j.jid.2017.09.044
Publisher URL https://www.jidonline.org/article/S0022-202X(17)33068-3/fulltext#articleInformation

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