Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study

Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study:

Publication date: January 2020

Source: Journal of the American Academy of Dermatology, Volume 82, Issue 1

Author(s): Emanuele Cozzani, Yiran Wei, Martina Burlando, Alessio Signori, Aurora Parodi

Background

Biologic therapy for psoriasis is effective but not always long-lasting and sometimes needs to be switched.

Objective

We aimed to evaluate the drug survival (ie, the time from initiation to discontinuation) of each biologic and the factors affecting survival to identify better switching strategies and improve drug survival.

Methods

In total, 195 psoriasis patients treated in our unit during 2006-2018 were retrospectively observed. Descriptive statistical analyses and logistic regression models were performed. Kaplan–Meier survival curves and multivariate Cox models adjusted for confounding variables were used to estimate and compare drug survival.

Results

Overall, 90.6% of patients achieved an ≥75% reduction in their baseline Psoriasis Area and Severity Index score. In 2018, the most frequently used biologic was ustekinumab (47/169, 27.8%). Patients with higher baseline Psoriasis Area and Severity Index scores were more likely to be switched (P = .0399, odds ratio 1.08). In naive patients, ustekinumab showed longer drug survival (>7.0 years), but in biologic-experienced patients, we found no significant differences in drug survival. Previous biologic therapies increased the need for switching (P = .014, hazard ratio 1.20). Switching between biologic classes yielded longer drug survival than switching within biologic classes (P = .003, hazard ratio 0.48).

Limitations

As a single-center, retrospective real-life study, the data were not perfectly homogeneous.

Conclusion

Switching between biologic classes might increase drug survival but retrospective studies designed ad hoc are needed to confirm this better switching strategy.