Real‐world drug survival and reasons for treatment discontinuation of biologics and apremilast in patients with psoriasis in an academic center

Abstract

The use of systemic agents is considered standard of care in patients with moderate to severe psoriasis, and these therapeutic agents are marked by a favorable risk-benefit profile, however, are plagued by high attrition. One questionnaire-based survey of 692 patients who had previously taken a biologic agent found that patients discontinued their medications after 11 to 20.5 months. 1 Our study aims to present additional real-world clinical data regarding the reasons behind discontinuation of these novel agents and the drug survival in an academic setting.A study cohort of 127 patients seen in a 5-year time frame at the departments of dermatology and/or rheumatology between June 2012 and April 2017 was identified by the following inclusion criteria: age greater than or equal to 18-years-old, visit diagnoses related to psoriasis and/or active psoriatic arthritis identified by ICD-9 and ICD-10 codes, and use of etanercept, adalimumab, infliximab, secukinumab, ustekinumab, or apremilast. Patients were excluded if Overall 444 (361, 525) Adalimumab 342 (280, 859) Infliximab 420 (223, 725) Etanercept 497 (364, 880) Secukinumab 504 (240, undecided) Ustekinumab 399 (278, 600) Apremilast 380 (274, 510)Note: P = .6893.

Apremilast and biologics: Characteristics of patients treated with apremilast before, during, or after a biological treatment

“…Therefore, these are complex patients with treatment‐resistant disease. Data obtained by our drug survival analysis are consistent with those obtained in other studies, which also found no differences in the duration of treatment depending on the characteristics of the patients, including previous biological treatment 6,7,13,14 . However, in our study CKD was associated with shorter treatment duration.…”

“…Data obtained by our drug survival analysis are consistent with those obtained in other studies, which also found no differences in the duration of treatment depending on the characteristics of the patients, including previous biological treatment. 6,7,13,14 However, in our study CKD was associated with shorter treatment duration. To our knowledge, no other studies have described apremilast survival depending on the presence of CKD.…”

Apremilast survival and reasons for discontinuation in psoriasis: five-year experience from a Greek tertiary care centre

“…In a cohort of patients with palmoplantar pustulosis, however, apremilast was associated with the longest survival (65 weeks) comparing to classic systemic treatments, such as cyclosporine, acitretin plus PUVA, methotrexate, acitretin, alitretinoin and fumaric acid esters [13]. Primary treatment failure was the most common reason for apremilast discontinuation in a USA study comparing various biologics and apremilast as well as in a smaller Austrian study [5,10]. Loss of efficacy was the main reason for apremilast cessation in a Japanese study (46.4%) [9].…”

“…Psoriasis treatment with biologics and small-molecule agents is of finite duration, most often due to efficacy-related reasons [3] The probability that psoriasis patients will stay on a biologic treatment for ≥3 years is 53%-58% [4]. Anti-drug antibodies, genomic and transcriptomic parameters as well as non-compliance could possibly explain this phenomenon [4,5]. Forty-five of 382 (11.78%) ESTEEM 2 participants, who received apremilast, discontinued treatment due to lack of efficacy by week 52 [2].…”

Retrospective study of apremilast drug survival in psoriasis patients in a daily practice setting: A long‐term experience

“…It is especially useful for patients in whom the use of biologic drugs it to be avoided (e.g., those with cancer, latent tuberculosis infection, or infective hepatitis). However, little is known about the drug survival associated with apremilast, in the real world, especially in the long term 2–19 . Moreover, there is also a variability in the term survival of Apremilast (APR) and its predictive factors for the treatment of psoriasis.…”