Long-term drug survival and predictor analysis of the whole psoriatic patient population on biological therapy in Hungary

Abstract

Persistence is an important component of therapeutic success, which depends on a variety of factors. Persistence measured under optimal conditions during clinical trials does not necessarily coincide with persistence observed in the real-world settings. The aim of the present study was to compare persistence rate of TNF-alpha inhibitors and interleukin 12/23 inhibitor in all psoriasis patients in Hungary, as well as to analyze the predictors of persistence. Data collected from 1263 patients over a period of 46 months were subjected to a retrospective analysis. Drug survival rate has been calculated according to Kaplan-Meier analysis and Cox regression was used to study the predictors. The overall persistence rate for the four biologicals exceeded 60% after 3 years. The persistence rate of ustekinumab at 3 years was 67.83%, which was superior compared to that of the TNF-alpha inhibitors, where the mean persistence rate was shown to be 50.76% (p < .05). Male patients showed significantly higher persistence than females (HR ¼ .76, p < .05 CI: 0.63, 0.92). Age, therapy-naïve status and use of concomitant MTX did not have significant effect on drug survival. Persistence rate of ustekinumab was significantly higher than that of TNF-alpha inhibitors, and among predictors, only male gender influenced persistence significantly. ARTICLE HISTORY

Factors predicting persistence of biologic drugs in psoriasis: a systematic review and meta‐analysis

“…We also wanted to interpret the influence of the predictors (female sex, obesity, psoriatic arthritis) regardless of the choice of biologic. Female sex consistently predicted biologic discontinuation in the included studies for the biologics combined group, 15,17,18,[31][32][33][34] adalimumab alone 34,41 and etanercept alone (Fig. 2).…”

“…2). 31,34,36 Female sex also predicted biologic discontinuation due to side-effects for the combined biologics group 17,32 and for adalimumab 31 and etanercept ( Fig. S1; see Supporting Information).…”

“…It therefore can be inferred that side‐effects play a greater role in biologics for female patients, and therefore biologic discontinuation. The reason for worsened drug persistence rates in female patients is currently unknown, although it is hypothesized that it may be due to biological differences in the development of antidrug antibodies and therapeutic dissatisfaction …”

“…The reason for worsened drug persistence rates in female patients is currently unknown, although it is hypothesized that it may be due to biological differences in the development of antidrug antibodies and therapeutic dissatisfaction. 20,34 The pooled analysis showed obesity as a consistent predictor of overall biologic discontinuation for the biologics combined, 15,17,31,37 etanercept alone 31,36 and ustekinumab alone, 31 but it was not significant for adalimumab alone (Fig. 3).…”

“…The predictive factors analysed in at least two studies were meta-analysed, leading to the inclusion of female sex, obesity and psoriatic arthritis in the pooled analysis. In total 13 cohort studies were included in the meta-analysis (n = 29 802): nine for female sex (n = 28 090), 15,17,18,[31][32][33][34][35][36] six for obesity (n = 9311) 15,17,31,[35][36][37] and six for psoriatic arthritis (n = 24 444) ( Fig. 1 and Tables S1 and S2; see Supporting Information).…”