title: Body mass index predicts discontinuation due to ineffectiveness and female sex predicts discontinuation due to side-effects in patients with psoriasis treated with adalimumab, etanercept or ustekinumab in daily practice: a prospective, comparative, long-term drug-survival study from the BioCAPTURE registry.
abstract: BACKGROUND
  Predictors for successful treatment are important for personalized medicine. Predictors for drug survival of biologics in psoriasis have been assessed, but not split for different biologics or for the reason of discontinuation.
  
  
  OBJECTIVE
  To compare long-term drug survival between the outpatient biologics adalimumab, etanercept and ustekinumab in patients with psoriasis, and to elucidate predictors for overall survival and drug discontinuation due to ineffectiveness and side-effects for each biologic separately.
  
  
  METHODS
  Ten years of data were extracted from the prospective, multicentre, long-term BioCAPTURE registry. Kaplan-Meier survival analyses and confounder-corrected multivariate Cox regression analysis for drug survival (MCR-DS) were performed to compare drug survival between biologics. To elucidate the predictors for different reasons of discontinuation for each biologic, univariate Cox regression analyses and multivariate Cox regression analyses for predictors (MCR-P) with backward selection were performed.
  
  
  RESULTS
  In total, 526 treatment episodes - 186 adalimumab, 238 etanercept and 102 ustekinumab - were included covering 1333 treatment years. MCR-DS showed a significantly higher overall survival for ustekinumab compared with adalimumab and etanercept. MCR-P showed that higher body mass index (BMI) was a predictor for discontinuation due to ineffectiveness for etanercept and ustekinumab and that female sex was a predictor for discontinuation due to side-effects for adalimumab, etanercept and ustekinumab.
  
  
  CONCLUSIONS
  Ustekinumab has the highest confounder-corrected long-term drug survival in psoriasis treatment, compared with adalimumab and etanercept. Higher BMI is a predictor for discontinuation due to ineffectiveness in etanercept and ustekinumab, and female sex is a consistent predictor for discontinuation due to side-effects in all three outpatient biologics.
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Zweegers
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: J M P A
authors.initials: JM
authors.lastname: van den Reek
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Otero
authors.affiliation: Maxima Medisch Centrum, Eindhoven/Veldhoven, the Netherlands.
authors.forename: A L A
authors.initials: AL
authors.lastname: Kuijpers
authors.affiliation: Gelre Ziekenhuizen, Apeldoorn, the Netherlands.
authors.forename: M I A
authors.initials: MI
authors.lastname: Koetsier
authors.affiliation: Ziekenhuis Gelderse Vallei, Ede, the Netherlands.
authors.forename: W P
authors.initials: WP
authors.lastname: Arnold
authors.affiliation: Slingeland Ziekenhuis, Doetinchem, the Netherlands.
authors.forename: M A M
authors.initials: MA
authors.lastname: Berends
authors.affiliation: Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Weppner-Parren
authors.affiliation: Ziekenhuisgroep Twente, Almelo, Hengelo, the Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Ossenkoppele
authors.affiliation: Ziekenhuisgroep Twente, Almelo, Hengelo, the Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Njoo
authors.affiliation: St Anna Ziekenhuis, Geldrop, the Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Mommers
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: P P M
authors.initials: PP
authors.lastname: van Lümig
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: R J B
authors.initials: RJ
authors.lastname: Driessen
authors.affiliation: Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Kievit
authors.affiliation: Department of Dermatology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, the Netherlands.|Radboud University, Nijmegen, the Netherlands.
authors.forename: E M G J
authors.initials: EM
authors.lastname: de Jong
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001685:Biological Factors / Q000009:adverse effects; D015992:Body Mass Index; D004334:Drug Administration Schedule; D057915:Drug Substitution; D000068800:Etanercept / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D012042:Registries; D012727:Sex Characteristics; D000069549:Ustekinumab / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000893:Anti-Inflammatory Agents; D001685:Biological Factors; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept