Persistence, effectiveness, and real‐world outcomes in psoriasis patients treated with secukinumab in Portugal

Abstract

To characterize moderate to severe psoriasis (PsO) adult patients treated with secukinumab, estimate drug persistence and assess any reasons for treatment discontinuation. Non‐interventional, retrospective, longitudinal record‐based study including patients diagnosed with PsO who started secukinumab between January 2018 and January 2020. Baseline characteristics were analyzed by descriptive statistics; drug persistence and predictive factors were assessed through Kaplan–Meier curves and univariate and multivariate analysis, respectively. A total of 302 patients were included in the study: mean age was 48.4 years, 41.7% were female, median time since diagnosis was 12.9 years. 51.3% of patients were bio‐naïve while 48.7% had previously been treated with biologics. PsO in difficult‐to‐treat locations (DTL) was present in 82.1% of patients, with scalp PsO in about half of patients. At 5‐years follow‐up, 84 patients discontinued secukinumab, 45 of which due to loss of efficacy. At week 104, overall treatment persistence was 71.7%. A higher probability of drug persistence was identified among those patients who initiated secukinumab ≥5 years after diagnosis, were bio‐naïve or treated with only one previous biologic, had no PsO on DTL, and had diabetes mellitus. The predictive factors for discontinuation identified in our study were the start of secukinumab <5 years after diagnosis (p = 0.001), the bio‐experimented status with ≥2 biologics (p = 0.007), and the presence of PsO on DTL (p = 0.014). A time since diagnosis of ≥5 years, naïve status or previous use of only one biologic are predictors for secukinumab persistence, whereas the presence of PsO on DTL predicts drug discontinuation.

Long‐term secukinumab efficacy and safety in bio‐naïve patients with moderate‐to‐severe cutaneous psoriasis: A real‐world retrospective noninterventional multicentric experience (128 patients)

“…Regarding on the efficacy in bio-naïve subjects assessed by absolut-PASI ≤3, and drug survival, our results are similar to those obtained in previous reports, and slightly higher to those obtained in clinical trials, but our mean follow-up period is longer. 1,7,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Furthermore, in our study both secukinumab response and drug survival in non-biologic-experienced patients were found to be independent of weight, age, sex and the presence of psoriatic arthritis, in contrast with some previously reported series 11,14,18,19 which also included biologicalexperienced subjects, what could explain these facts. We wanted to highlight the low incidence of psoriatic arthritis (18.8%), diabetes (14.8%) and cardiac failure (3.9%) in our study.…”

“…1,5 Secukinumab is a fully human monoclonal antibody that selectively neutralizes IL-17A which has demonstrated its efficacy and safety profile in the treatment of PsA, pustular, erythrodermic 6 and moderate-to-severe cutaneous psoriasis, (including special areas) in both phase III trials [7][8][9][10] and real-life series. [11][12][13][14][15][16] Recent research works have reported that psoriatic patients treated with secukinumab exhibit a very fast clinical response associated also with the downregulation of inflammatory mediators in the skin. Therefore, secukinumab treatment in early-stage psoriasis may interrupt the migration of IL-17A-producing cells to inflamed tissues (targeting both clinical and subclinical inflammation) and even prevent PsA development or psoriasis related comorbidities, contributing to longer periods of treatment-free remission, disease modification and improving the global disease control.…”

“…Considering these findings, it has been hypothesized that early psoriasis might be different from chronic and treatment‐resistant disease, with only few effector/memory IL‐17+ T cells invading the inflamed skin, so early disease interception with IL‐17 inhibitors may result in better outcomes for the patients 1,5 . Secukinumab is a fully human monoclonal antibody that selectively neutralizes IL‐17A which has demonstrated its efficacy and safety profile in the treatment of PsA, pustular, erythrodermic 6 and moderate‐to‐severe cutaneous psoriasis, (including special areas) in both phase III trials 7–10 and real‐life series 11–16 . Recent research works have reported that psoriatic patients treated with secukinumab exhibit a very fast clinical response associated also with the downregulation of inflammatory mediators in the skin.…”

Drug survival of biologics and non‐biologics in patients affected by palmoplantar psoriasis: a “real‐world”, mono‐center experience

“…Palmoplantar involvement is considered a difficult‐to‐treat site 11 and a negative predictor of response to treatment in patients with psoriasis 12,13 …”

“…Palmoplantar involvement is considered a difficult-to-treat site 11 and a negative predictor of response to treatment in patients with psoriasis. 12,13 Few data on the prevalence of PP in both sexes are also available to date. Based on data collected in a recent systematic review, 3 the prevalence of PP is slightly higher in the male population, and the most frequent subtype of the two variants was hyperkeratotic.…”