Persistence of biologic treatments in psoriatic arthritis: a population-based study in Sweden

Abstract

Objectives TNF inhibitors (TNFis) and IL inhibitors are effective treatments for PsA. Treatment non-persistence (drug survival, discontinuation) is a measure of effectiveness, tolerability and patient satisfaction or preferences in real-world clinical practice. Persistence on these treatments is not well understood in European PsA populations. The aim of this study was to compare time to non-persistence for either ustekinumab (IL-12/23 inhibitor) or secukinumab (IL-17 inhibitor) to a reference group of adalimumab (TNFi) treatment exposures in PsA patients and identify risk factors for non-persistence. Methods A total of 4649 exposures of adalimumab, ustekinumab, and secukinumab in 3918 PsA patients were identified in Swedish longitudinal population-based registry data. Kaplan–Meier curves were constructed to measure treatment-specific real-world risk of non-persistence and adjusted Cox proportional hazards models were estimated to identify risk factors associated with non-persistence. Results Ustekinumab was associated with a lower risk of non-persistence relative to adalimumab in biologic-naïve [hazard ratio (HR) 0.48 (95% CI 0.33, 0.69)] and biologic-experienced patients [HR 0.65 (95% CI 0.56, 0.76)], while secukinumab was associated with a lower risk in biologic-naïve patients [HR 0.65 (95% CI 0.49, 0.86)] but a higher risk of non-persistence in biologic-experienced patients [HR 1.20 (95% CI 1.03, 1.40)]. Biologic non-persistence was also associated with female sex, axial involvement, recent disease onset, biologic treatment experience and no psoriasis. Conclusion Ustekinumab exhibits a favourable treatment persistency profile relative to adalimumab overall and across lines of treatment. The performance of secukinumab is dependent on biologic experience. Persistence and risk factors for non-persistence should be accounted for when determining an optimal treatment plan for patients.

Sustained and improved guselkumab response in patients with active psoriatic arthritis regardless of baseline demographic and disease characteristics: pooled results through week 52 of two phase III, randomised, placebo-controlled studies

“…A similar effect of decreased efficacy in obese patients with PsA was observed in post-hoc analyses from two phase III studies of the Janus kinase (JAK) inhibitor, tofacinitib 16. Patient sex also correlates with treatment persistence,17–19 as does inadequate response to biologicals, with the use of each subsequent biological yielding successively lower rates of drug persistence 17 19–21. However, the difficult-to-treat inadequate responder subpopulation may initially experience greater efficacy responses by switching to an alternative biological following failure of ≥1 TNFi 22.…”

Persistence and effectiveness of the IL-12/23 pathway inhibitor ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: 1-year results from the real-world PsABio Study

“…significantly longer treatment persistence and lower discontinuation rates compared with those initiating a TNFi during 1 year follow-up 32 and those initiating adalimumab during 10 years follow-up. 26 Likewise, the subgroup of patients with PsA in the PSOLAR Study, a registry study of 12 095 patients with psoriasis, showed better drug persistence with ustekinumab versus TNFi. 19 This difference in results of adjusted analyses between the PsABio Study and the other studies could be due to various reasons: prospective non-interventional study setting, as done here, is different from retrospective claims database or registry analysis; the ustekinumab population in the current study was heavily affected by comorbidities, chronic widespread pain, late lines of bDMARD treatment, which may have impacted drug persistence with ustekinumab in this prospective patient cohort versus the other studies, and these or additional non-assessed imbalances may not have been fully adjusted for.…”

“…19 A retrospective Swedish registry study with a maximum follow-up of 10.6 years demonstrated favourable persistence with ustekinumab versus adalimumab across treatment lines. 26 Six-month data from the prospective, observational PsABio cohort study of ustekinumab and TNFi treatment in patients with PsA indicated that later line of treatment, female sex and comorbidities as well as baseline disease impact, high clinical disease activity, and chronic widespread pain were shown to negatively influence treatment response. 27 Here we present data on persistence, the primary outcome of PsABio, as well as clinical effectiveness, disease impact and safety after 1 year of follow-up.…”

Patient characteristics associated with use of TNF vs interleukin inhibitors as first-line biologic treatment for psoriatic arthritis

“…33 In contrast, registry-based studies such as PSOriasis Longitudinal Assessment and Registry (PSOLAR), British Association of Dermatologists Biologic Interventions Register (BADBIR), and a population study using Swedish administrative registries reported a better drug survival of ustekinumab compared with TNF inhibitors among PsA or psoriasis patients. [34][35][36] Nevertheless, data in these studies and in our study are limited to further identify specific reasons for treatment discontinuation or switching.…”