33894 Drug survival 2.0 – Real-world dosing of biologics for psoriasis

Abstract

Background: The efficacy of biologics in psoriasis are gauged by drug survival studies. This approach may miss treatment failures and successes in the form of dose-escalation and dose-reduction. Methods: Using the prospective nation-wide DERMBIO database (2007-2019 nov), we included all patients diagnosed with plaque psoriasis and treated with a biologic in Denmark. Patients were stratified according to treatment. Dose escalation and reduction were defined as an increase or decrease in the prescribed dose when compared with the labelled dose. Drug failure was defined as either dose-escalation or discontinuation of treatment. Kaplan-Meier curves were used to present the augmented survival curves. Cox regression models with robust variance were used to compare the risk of the following three outcomes dose escalation, dose escalation or discontinuation, and dose reduction. Results: We included a total of 2863 patients. 37% were woman and the average age 50 years. Half of patients were bio-naïve. The following number of patients received the examined biologics: 1673 adalimumab, 1418 ustekinumab, 825 secukinumab, 33 brodalumab, 199 ixekizumab, and 84 guselkumab. Escalation and/or discontinuation were more frequent in bio-experienced patients. Most biologics were discontinued rather than escalated, expect for ustekinumab. The risk of failure was higher for ustekinumab. Secukinumab demonstrated the largest discrepancy when between bio-naivety and bio-experienced patients. Dose reduction was more likely in patients treated with adalimumab and ustekinumab. Conclusion: When defining treatment failure as either dose-escalation and/or discontinuation, adalimumab and secukinumab performed significantly better than ustekinumab, while guselkumab demonstrated a nonsignificant signal toward a lower risk of failure.