Drug Survival of Interleukin (IL)-17 and IL-23 Inhibitors for the Treatment of Psoriasis: A Retrospective Multi-country, Multicentric Cohort Study
Por:
Torres, T, Puig, L, Vender, R, Yeung, J, Carrascosa, JM, Piaserico, S, Gisondi, P, Lynde, C, Ferreira, P, Bastos, PM, Dauden, E, Leite, L, Valerio, J, del Alcazar-Viladomiu, E, Rull, EV, Llamas-Velasco, M, Pirro, F, Messina, F, Bruni, M, Licata, G, Ricceri, F, Nidegger, A, Hugo, J, Mufti, A, Daponte, AI, Teixeira, L, Balato, A, Romanelli, M, Prignano, F, Gkalpakiotis, S, Conrad, C, Lazaridou, E, Rompoti, N, Papoutsaki, M, Nogueira, M, Chiricozzi, A
Publicada:
1 nov 2022
Ahead of Print:
1 ago 2022
Resumen:
Background Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. Objective The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. Methods This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. Conclusion The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities >= 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab.
Filiaciones:
Torres, T:
Univ Porto, Inst Ciencias Biomed Abel Salazar, Porto, Portugal
Ctr Hosp Univ Porto, Dept Dermatol, Porto, Portugal
Puig, L:
Hosp Santa Creu & Sant Pau, Dept Dermatol, Barcelona, Spain
Vender, R:
McMaster Univ, Hamilton, ON, Canada
Yeung, J:
Univ Toronto, Dept Med, Div Dermatol, Prob Med Res, Waterloo, ON, Canada
Carrascosa, JM:
Autonomous Univ Barcelona UAB, Germans Trias & Pujol Univ Hosp HUGTP, Dept Dermatol, Badalona, Spain
Piaserico, S:
Univ Padua, Dept Med, Dermatol Unit, I-35128 Padua, Italy
Gisondi, P:
Univ Verona, Dept Med, Sect Dermatol & Venereol, Verona, Italy
Lynde, C:
Univ Toronto, Lynde Inst Dermatol, Dept Med, Toronto, ON, Canada
Ferreira, P:
Hosp CUF Descobertas, Lisbon, Portugal
Bastos, PM:
Hosp CUF Descobertas, Lisbon, Portugal
Dauden, E:
Hosp Univ La Princesa, Inst Invest Sanitaria La Princesa IIS IP, Dermatol Dept, Madrid, Spain
Leite, L:
Clin Med Belem, Lisbon, Portugal
Valerio, J:
Clin Med Belem, Lisbon, Portugal
del Alcazar-Viladomiu, E:
Autonomous Univ Barcelona UAB, Germans Trias & Pujol Univ Hosp HUGTP, Dept Dermatol, Badalona, Spain
Rull, EV:
Hosp Santa Creu & Sant Pau, Dept Dermatol, Barcelona, Spain
Llamas-Velasco, M:
Hosp Univ La Princesa, Inst Invest Sanitaria La Princesa IIS IP, Dermatol Dept, Madrid, Spain
Pirro, F:
Univ Cattolica Sacro Cuore, Dipartimento Med & Chirurg Traslaz, Dermatol, Rome, Italy
Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Sci Med & Chirurg, UOC Dermatol, Rome, Italy
Messina, F:
Univ Padua, Dept Med, Dermatol Unit, I-35128 Padua, Italy
Bruni, M:
Univ Verona, Dept Med, Sect Dermatol & Venereol, Verona, Italy
Licata, G:
Univ Brescia, Dermatol Dept, ASST Spedali Civili Brescia, Brescia, Italy
Ricceri, F:
Univ Florence, Dept Dermatol Sci, Sect Dermatol, Florence, Italy
Nidegger, A:
Univ Lausanne, Lausanne, Switzerland
Lausanne Univ Hosp CHUV, Dept Dermatol, Lausanne, Switzerland
Hugo, J:
Charles Univ Prague, Fac Med 3, Dept Dermatovenereol, Prague, Czech Republic
Kralovske Vinohrady Univ Hosp, Prague, Czech Republic
Mufti, A:
Univ Toronto, Dept Med, Div Dermatol, Prob Med Res, Waterloo, ON, Canada
Daponte, AI:
Aristotle Univ Thessaloniki, Dept Dermatol Venereol 2, Sch Med, Thessaloniki, Greece
Teixeira, L:
Univ Porto ICBASUP, Ctr Hlth Technol & Serv Res CINTESIS, Inst Biomed Sci Abel Salazar, Porto, Portugal
Balato, A:
Univ Campania Luigi Vanvitelli, Unit Dermatol, Naples, Italy
Romanelli, M:
Univ Pisa, Dept Dermatol, Pisa, Italy
Prignano, F:
Univ Florence, Dept Dermatol Sci, Sect Dermatol, Florence, Italy
Gkalpakiotis, S:
Kralovske Vinohrady Univ Hosp, Prague, Czech Republic
Charles Univ Prague, Fac Med 3, Dept Dermatovenereol, Prague, Czech Republic
Conrad, C:
Lausanne Univ Hosp CHUV, Dept Dermatol, Lausanne, Switzerland
Univ Lausanne, Lausanne, Switzerland
Lazaridou, E:
Aristotle Univ Thessaloniki, Dept Dermatol Venereol 2, Sch Med, Thessaloniki, Greece
Rompoti, N:
Natl & Kapodistrian Univ Athens, A Sygros Hosp Skin & Venereal Dis, Fac Med, Dept Dermatol Venereol 1, Athens, Greece
Papoutsaki, M:
Natl & Kapodistrian Univ Athens, A Sygros Hosp Skin & Venereal Dis, Fac Med, Dept Dermatol Venereol 1, Athens, Greece
Nogueira, M:
Ctr Hosp Univ Porto, Dept Dermatol, Porto, Portugal
Chiricozzi, A:
Univ Cattolica Sacro Cuore, Dipartimento Med & Chirurg Traslaz, Dermatol, Rome, Italy
Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Sci Med & Chirurg, UOC Dermatol, Rome, Italy
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