Secukinumab drug survival in patients with psoriasis: A multicenter, real-world, retrospective study

Abstract

To the Editor: Secukinumab, an interleukin 17A inhibitor approved for the treatment of moderate-tosevere plaque psoriasis, has shown high levels of clinical efficacy and a favorable safety profile in both short-term and long-term clinical trials. However, in some studies in the real-life setting, secukinumab showed a 73%-78% drug survival at 12 months, shorter than that of other biologic agents, even among biologic-naive patients, and loss of effectiveness was the most common reason for discontinuation. 1-4 To evaluate drug survival of secukinumab in a daily practice setting, we retrospectively evaluated all psoriatic patients starting secukinumab during January 2016-February 2017 at 11 centers in 3 European countries and followed them until February 2018 (potentially with at least 1 year of observation period). Failure was defined as stopping secukinumab definitively or switching to a different therapy. Drug survival was analyzed using KaplaneMeier methodology. A total of 330 patients were included. Their median 6 standard deviation age was 51.9 6 14.6 years, 68% were male, and 19.6% were obese (body mass index [BMI] $30 kg/m 2); 21.5% of patients had a diagnosis of psoriatic arthritis, and 52.4% were biologic-experienced (24.5% with $2 prior biologics). All patients were treated with the 300-mg label dose, and there was no dose adjustment throughout the treatment. Concomitant systemic therapy was used in 12% of patients (mostly methotrexate). Overall drug survival of secukinumab was 83% after 12 months and 78.8% after 18 months (Fig 1, A). The dropout rate at 18 months was 20%: 12.4% of patients were lost to follow-up, 6.7% of patients stopped because of drug ineffectiveness, 0.3% of patients discontinued because of adverse events, and 0.6% of patients decided to quit the drug. Drug survival rates at 12 and 18 months were lower for biologic-experienced than biologic-naive patients (Fig 1, B) and lower in obese than nonobese patients. Patients treated with concomitant systemic therapies also showed a lower drug survival rate than those treated with secukinumab monotherapy at 12 months (79.5% vs 94.2%, respectively) and 18 months (53.7% vs 81.8%, respectively). Univariate Cox regression analysis of drug survival determinants showed that prior use of [1

Real‐world efficacy and safety of interleukin‐17 inhibitors for psoriasis: A single‐center experience

“…Regarding secukinumab, drug survival was reported in 83-368 enrolled patients in observation periods ranging from 12 months to 3 years and 4 months. [8][9][10][11] The 12-and 18-month overall drug survivals of secukinumab were 76-83% and 67-78.8%, respectively, and higher drug survival was shown in bio-na€ ıve patients than in bio-experienced patients with or without statistical significance. [8][9][10] Our data showed similar results.…”

“…[8][9][10][11] The 12-and 18-month overall drug survivals of secukinumab were 76-83% and 67-78.8%, respectively, and higher drug survival was shown in bio-na€ ıve patients than in bio-experienced patients with or without statistical significance. [8][9][10] Our data showed similar results. One study with 83 patients who were studied for 12 months showed higher drug survival in bio-experienced patients than in bio-naive patients despite no statistical significance.…”

“…In our cohort, the mean BMI was slightly lower and the number of prior biologics was slightly smaller, compared with the previous reports from outside Japan. [8][9][10]12 Our study is limited by the small sample size and short study period. However, we showed high efficacy of IL-17i in real-world settings.…”

Secukinumab demonstrates improvements in absolute and relative psoriasis area severity indices in moderate-to-severe plaque psoriasis: results from a European, multicentric, retrospective, real-world study

“…Although secukinumab has been shown to be well tolerated and effective in treating patients with plaque psoriasis and PsA in multiple clinical trials (7-9,29-34) with up to 5-year follow up (35), randomized controlled trials are likely to enroll patient populations with more stringent inclusion/exclusion criteria and generally the study design allows a short-term observation compared to the real-world setting. A variety of real-world studies have been recently published: some of them analyzed secukinumab drug survival (36)(37)(38)(39), whereas others assessed its efficacy in psoriasis patient populations with peculiar features, or assessing its effectiveness as improvement of DLQI, BSA, PGA, and PASI scores (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Nevertheless, they reported favorable secukinumab safety and effectiveness in terms of mean reduction of PASI value over time, as patient rates achieving PASI 75, PASI 90, and PASI 100 responses at different timepoints, Investigator's Global Assessments or improvements in quality of life measures (11)(12)(13)(14)(15)(16)(17)(18)(19)22).…”

IL-17A in Psoriasis and Beyond: Cardiovascular and Metabolic Implications

“…Nevertheless, latest analyses of 21 clinical trials showed incidence rates of IBD comparable to untreated patients with psoriasis or psoriatic arthritis (57). Newest real-life data are confirming safety and tolerability of the IL-17 inhibitors also in daily practice, mirroring the evidence from clinical trials (58).…”