AD1 PERSISTENCE OF BIOLOGIC THERAPIES FOR THE TREATMENT OF PLAQUE PSORIASIS - A NATIONAL LONGITUDINAL OBSERVATIONAL POPULATION STUDY IN SWEDEN

Abstract

Recent observational studies suggest that persistence of biologic therapies in plaque psoriasis (psoriasis) differs from what is observed in clinical trials. The objective of this study is to assess the persistence of biologic therapies for the treatment of psoriasis in clinical practice in Sweden. A longitudinal observational population study was carried out using individual-level data from the Swedish National Patient Register, Prescribed Drug Register, and Cause-of-Death Register. Included patients were adults diagnosed with psoriasis, treated with a biologic between 2010-2018. Median treatment persistence and 1-year predicted persistence probabilities were estimated from Kaplan-Meier curves. Sub-group analysis was conducted with biologic-naïve vs. biologic-experienced patients. Biologic therapies with <20 patients and biologics used off label are not reported. 2,258 patients with 2,975 treatment periods were included (adalimumab: n=1,046, etanercept: n=974, ustekinumab: n=488, secukinumab: n=394, ixekizumab: n=50, and certolizumab pegol: n=23). Mean age at psoriasis diagnosis was 42.1 (SD 14.2); 62% were male; 78.7% had concomitant psoriasis medication; and 61% were biologic naïve (range: 12-93%) Overall median drug persistence was 23.8 months (95% CI: 21.6-26.2). For biologics reaching 50% drug continuation, median persistence ranged from 49.3 months (95% CI: 38.0-59.1, ustekinumab) to 9.3 months (95% CI: 6.4-18.1, certolizumab pegol). Secukinumab and ixekizumab did not reach the 50% drug continuation probability threshold. The proportion of persistent patients after 1 year was highest for ixekizumab (81.3%), followed by ustekinumab (79.9%), secukinumab (75.9%), adalimumab (64.6%), and etanercept (57.8%). Biologic-naïve patients had higher drug persistence than biologic-experienced patients for all treatments except certolizumab pegol and ixekizumab, both limited by low patient numbers. In this observational study in Sweden, median persistence was around 2 years for biologic therapies in psoriasis in clinical practice. The study indicates that modern biologic therapies may have higher persistence than traditional anti-TNFs, though potential confounders need to be explored further.