Long-term control of psoriasis may require several courses of different agents in some cases: JAMA
Long-term control of psoriasis (PsO) and psoriatic arthritis (PsA) for some patients may require several courses of different agents, a recent study has suggested. The findings were published in the journal JAMA Dermatology on March 23, 2022.
The study found that for PsO and PsA, IL-17 inhibitors are associated with higher treatment persistence than the TNF inhibitor. Also, interleukin 17 inhibitors are associated with higher persistence than the IL-12/23 inhibitor for PsA, with no difference for PsO. However, for all biologics, the persistence rates remained globally low at 3 years.
There is a continuous evolution of the treatment options for PsO and PsA throughout the era of biologics. Clinical trials are inadequate for assessing the relative long-term efficacy of biologics and are often insufficient regarding safety. To fill this knowledge gap, Laura Pina Vegas, EpiDermE, Université Paris Est Créteil, Créteil, France, and colleagues aimed to assess the long-term persistence of different biologic classes to treat PsO and PsA in a nationwide cohort study.
The study involved the administrative health care database of the French health insurance scheme linked to the hospital discharge database. The study included all adults with PsO and PsA who were new users of biologics (not in the year before the index date) from January 1, 2015, to May 31, 2019. Those patients who were hospitalized for PsA in the PsO cohort and for PsO in the PsA cohort in the year before the index date were excluded. Data analysis was done from June 1 to October 31, 2021.
Persistence was defined as the time from biologic therapy initiation to discontinuation. It was estimated using the Kaplan-Meier method. The researchers then compared persistence by biologic class involved using propensity score–weighted Cox proportional hazards regression models.
The analysis included a total of 16 892 patients with PsO were included in the analysis (mean age, 48.5 years; 9152 men [54.2%] men).
The findings of the study were as follows:
- Of 16 892 patients with PsO included in the analysis, 60.4% started therapy with a tumor necrosis factor (TNF) inhibitor; 23.6%, with an interleukin 12 and interleukin 23 (IL-12/23) inhibitor; and 16.0%, with an interleukin 17 (IL-17) inhibitor.
- An additional 6531 patients with PsA (mean age, 49.1 years; 54.6% women) were included; of these, 76.2% started therapy with a TNF inhibitor; 12.3%, with an IL-12/23 inhibitor; and 11.5%, with an IL-17 inhibitor.
- Overall 3-year persistence rates were 40.9% and 36.2% for PsO and PsA, respectively. After inverse probability of treatment weighting and adjustment, the IL-17 inhibitor was associated with higher persistence compared with the TNF inhibitor for PsO (weighted hazard ratio [HR], 0.78) and PsA (weighted HR, 0.70) and compared with the IL-12/23 inhibitor for PsA (weighted HR, 0.69).
- No difference between the IL-17 inhibitor and IL-12/23 inhibitor for PsO was noted.
- The IL-12/23 inhibitor was associated with higher persistence than the TNF inhibitor for PsO (weighted HR, 0.76), with no difference observed for PsA.
To conclude, treatment persistence rates at 3 years for first-line biologic agents (TNF-α inhibitors, IL-12/23 inhibitors, and IL-17 inhibitors) was low, with IL-17 inhibitors exhibiting the highest persistence.
Reference:
Pina Vegas L, Penso L, Claudepierre P, Sbidian E. Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database. JAMA Dermatol. Published online March 23, 2022. doi:10.1001/jamadermatol.2022.0364
