Drug survival and clinical effectiveness of secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, tildrakizumab for psoriasis treatment.

Abstract

Biologics targeting IL-23 and IL-17 show efficacy and safety in the treatment of moderate-to-severe psoriasis. To investigate drug survival in patients with psoriasis treated with biologics. We performed a comparative evaluation of the achievement of PASI90 and PASI ≤ 3 at 16, 28, and 52weeks along with a DS (drug survival) analysis with IL-17 and IL-23 inhibitors brodalumab, ixekizumab, secukinumab, risankizumab, tildrakizumab, and guselkumab on 1,057 patients. IL-17 inhibitors showed a faster achievement of PASI90 and PASI ≤3 with significant superiority over IL-23 inhibitors at week 16 (p<0.001; 56% vs. 42% and 70% vs. 59%, respectively). A difference was shown in favor of IL-23 inhibitors regarding DS (p<0.001), which was 88% at 24 months vs. 75% for IL-17 inhibitors. In multivariate analysis, IL-23 inhibitors (HR 0.54 CI 0.37-0.78, p=0.001), and male sex (HR 0.57 CI 0.42-0.76, p<0.001) were all associated with a lower probability of drug interruption. Risankizumab (HR 0.42 CI 0.26-0.69, p=0.001), guselkumab (HR 0.49 CI 0.24-0.99, p=0.046), and male sex (HR 0.57 CI 0.43-0.77, p<0.001) were associated with a lower probability of drug interruption than secukinumab. IL-23 inhibitors showed the best performance on DS. Overall, the most effective class was IL-17 inhibitors considering the short-term effectiveness, but long-term effectiveness is in favor of anti-IL-23.