Does a Drug's Mechanism Regulate Retention by Patients With Psoriasis?

A study in Israel, comparing use of ustekinumab (Stelara) and 3 other biologics used to treat inflammatory conditions has found that patients stayed on the drug longer compared with its comparators.

The authors of the study conducted a “drug survival” analysis among 907 patients with severe psoriasis who received adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), and ustekinumab for the treatment of psoriasis, using data drawn from a large health maintenance organization in Israel.

In their patient cohort, the authors documented 1575 biologic treatments and 865 discontinuation of treatments. Ustekinumab, which inhibits interleukin 12 and 23, had a significantly higher survival rate (40.8 months) than either one of the other 3 drugs, all tumor necrosis factor inhibitors. Adalimumab averaged at 26.4 months, etanercept at 26.35 months, and infliximab at 23.9 months.

Important positive predictors of drug survival, the authors report, included treatment naivety and concomitant methotrexate intake. On the other hand, duration of the previous treatment as well as female gender were negative predictors of survival.

The authors concluded that biologics efficacy in real-life clinical practice decreases over time. They also noted that while ustekinumab survived longer among patients, most of its use was as a third-line in patients with severe psoriasis.

Reference

Shalom G, Cohen AD, Ziv M, et al. Biologic drug survival in Israeli psoriasis patients [published online December 28, 2016]. J Am Acad Dermatol. pii: S0190-9622(16)31008-8. doi: 10.1016/j.jaad.2016.10.033.