title: Differential Drug Survival of Biologic Therapies for the Treatment of Psoriasis: A Prospective Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR).
abstract: Drug survival reflects a drug's effectiveness, safety, and tolerability. We assessed the drug survival of biologics used to treat psoriasis in a prospective national pharmacovigilance cohort (British Association of Dermatologists Biologic Interventions Register (BADBIR)). The survival rates of the first course of biologics for 3,523 biologic-naive patients with chronic plaque psoriasis were compared using survival analysis techniques and predictors of discontinuation analyzed using a multivariate Cox proportional hazards model. Data for patients on adalimumab (n=1,879), etanercept (n=1,098), infliximab (n=96), and ustekinumab (n=450) were available. The overall survival rate in the first year was 77%, falling to 53% in the third year. Multivariate analysis showed that female gender (hazard ratio (HR) 1.22; 95% confidence interval (CI): 1.09-1.37), being a current smoker (HR 1.19; 95% CI: 1.03-1.38), and a higher baseline dermatology life quality index (HR 1.01; 95% CI: 1.00-1.02) were predictors of discontinuation. Presence of psoriatic arthritis (HR 0.82; 95% CI: 0.71-0.96) was a predictor for drug survival. As compared with adalimumab, patients on etanercept (HR 1.63; 95% CI: 1.45-1.84) or infliximab (HR 1.56; 95% CI: 1.16-2.09) were more likely to discontinue therapy, whereas patients on ustekinumab were more likely to persist (HR 0.48; 95% CI: 0.37-0.62). After accounting for relevant covariates, ustekinumab had the highest first-course drug survival. The results of this study will aid clinical decision making when choosing biologic therapy for psoriasis patients.
authors.affiliation: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: christopher.griffiths@manchester.ac.uk.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warren
authors.affiliation: St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Smith
authors.affiliation: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: zenas.yiu@manchester.ac.uk.
authors.forename: Zenas Z N
authors.initials: ZZN
authors.lastname: Yiu
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, The University of Manchester, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
authors.affiliation: St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Jonathan N W N
authors.initials: JNWN
authors.lastname: Barker
authors.affiliation: Department of Dermatology, Western Infirmary, Glasgow, UK.
authors.forename: A David
authors.initials: AD
authors.lastname: Burden
authors.affiliation: Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McElhone
authors.affiliation: Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ormerod
authors.affiliation: Department of Dermatology, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Owen
authors.affiliation: Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, and Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Reynolds
authors.affiliation: Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: christopher.griffiths@manchester.ac.uk.
authors.forename: Christopher E M
authors.initials: CEM
authors.lastname: Griffiths
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage; D000328:Adult; D001688:Biological Products / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001691:Biological Therapy / Q000379:methods; D015331:Cohort Studies; D003880:Dermatology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068800:Etanercept / Q000008:administration & dosage / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000493:pharmacokinetics; D053208:Kaplan-Meier Estimate; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy*; D012042:Registries; D012955:Societies, Medical; D000069549:Ustekinumab / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D001688:Biological Products; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept