P70 The 1-year all-cause drug survival of bimekizumab compared with other biologics in psoriasis: a nationwide real-world cohort study

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Abstract Bimekizumab was approved by the European Medicines Agency for the treatment of moderate-to-severe plaque psoriasis in August 2021. Bimekizumab is the only biologic that exerts specific inhibition of interleukin (IL)-17A and IL-17F. Few real-world studies have assessed the drug survival of bimekizumab. We assessed the 1-year all-cause drug survival of the tumour necrosis factor (TNF)-α inhibitor adalimumab, the IL-12/23 inhibitor ustekinumab, the IL-17 inhibitors secukinumab, ixekizumab, brodalumab, and bimekizumab, and the IL-23 inhibitor guselkumab. We used data on adult patients with psoriasis that were extracted from a nationwide prospective psoriasis database in February 2024. Survival functions were estimated using the Kaplan–Meier method. Hazard ratios (HRs) were estimated using a Cox proportional hazards model adjusted for the a priori-defined covariates age, sex, body weight, psoriatic arthritis (PsA), and previous number of biologics. Proportional hazards and linearity were assessed using the cumulative residuals. If the proportionality assumption was violated, we explored the time-varying effects of covariates. We included 4165 patients with 6554 treatment series. There were 3064 treatment series with adalimumab, 1498 with ustekinumab, 856 with secukinumab, 555 with ixekizumab, 195 with brodalumab, 192 with bimekizumab, and 194 with guselkumab. The crude 1-year all-cause drug survival was highest for bimekizumab (83.7%) followed by ustekinumab (79.2%), guselkumab (76.5%), ixekizumab (73.9%), adalimumab (71.4%), secukinumab (70.1%), and brodalumab (60.3%). In the Cox proportional hazards model, we found that bimekizumab had a significantly lower discontinuation hazard than all the other investigated biologics except guselkumab [HR, 1.26; 95% confidence interval (CI), 0.76–2.09]. Compared with bimekizumab, the HR was 1.55 (95% CI, 1.00–2.39) for ixekizumab, 1.56 (95% CI, 1.03–2.38) for ustekinumab, 2.25 (95% CI, 1.48–3.43) for secukinumab, 2.61 (95% CI, 1.65–4.13) for brodalumab, and 2.65 (95% CI, 1.75–4.01) for adalimumab. The analysis found that sex and PsA had time-varying effects. The hazard was 135% higher for females compared with males (HR, 2.35; 95% CI, 1.95–2.84) in the first 100 days and, among those still on treatment after 100 days, the HR decreased to 1.57 (95% CI, 1.40–1.78). In the first 100 days, PsA was protective (HR, 0.69; 95% CI, 0.56–0.86) but PsA had no protective effect for those still on treatment after 100 days (HR, 0.98; 95% CI, 0.86–1.11). In conclusion, bimekizumab had the highest 1-year all-cause drug survival compared with adalimumab, ustekinumab, secukinumab, ixekizumab, and brodalumab but not guselkumab. Data on the long-term drug survival of bimekizumab, as well as the drug survival associated with effectiveness and safety, are needed.