The era of biologics has revolutionized the treatment options for patients with moderate to severe psoriasis in recent decades. Drug survival is an indicator of the longer-term efficacy and safety of a drug and is also considered a “real-life” indicator of therapy success. Therefore, together with the question of the predictability of treatment success, this is currently also the focus of several research groups.
Various criteria are taken into account when deciding on a particular system therapy. In contrast to conventional system therapeutics, biologics are generally better tolerated, especially in long-term treatment. This is also reflected in the fact that therapy with biologic drugs tends to be maintained longer compared to conventional systemic therapies. Currently available biologics selectively target key mediators of psoriasis pathogenesis, including TNFα, interleukin (IL)-12/IL-23, IL-17, and IL-23. In clinical trials, a PASI90 or PASI100 response was achieved in a significant proportion of patients treated with the respective biologics [2,8]. As with other immune-mediated chronic inflammatory diseases, the question of permanently effective therapies for psoriasis is the focus of interest for all involved.
“Drug Survival” as a Measure of Therapy Adherence
The period from initiation to discontinuation of a specific treatment is referred to as “drug survival” [3]. Drug survival” thus reflects the adherence to therapy, the long-term success of treatment and the patient’s satisfaction with the therapy. Prof. Carle Paul, MD, Centre Hospitalier Universitaire de Toulouse, France, presented, among others, results of recently published studies that addressed the issue of criterion-guided selection of biologics in a narrow or broader sense [4]. BADBIR (“British Association of Dermatologists Biologics and Immunomodulators Register”) is a large European cohort study comparing the drug survival of different biologics. In a 2022 publication in JAMA Dermatology, data from BADBIR were used to analyze the “drug survival” of adalimumab, ustekinumab, secukinumab, guselkumab, and ixekizumab [5,6]. This showed, among other things, that secukinumab and ixekizumab had similar “drug survival” curves over time and that treatment with guselkumab had a higher survival rate compared with ustekinumab, while adalimumab was inferior in this regard. In addition to psoriatic arthritis and nail involvement, prior exposure to biologics is also an effect modifier for efficacy-related “drug survival.” The latter proved to be generally lower in patients pretreated with biologics than in biologics-naive patients.
Can biologic response be predicted?
Evidence-based predictors of response to a biologic could contribute to optimized treatment decisions [1,4]. A research team in Denmark used artificial intelligence algorithms to build predictive models based on comprehensive national patient data. The results were also published in JAMA Dermatology 2022 [7]. The selection of therapies was criterion-guided with reference to current guidelines. The goal is to develop a system that allows physicians to select, within recommended therapies, the one most likely to lead to treatment success [1,7]. Among other things, the analysis shows that if a patient does not improve in the first phase of treatment, this reduces the likelihood of successful treatment with this active substance in the longer term. Another finding is that patients with psoriasis and psoriatic arthritis had a higher likelihood of success with secukinumab than with TNF inhibitors or ustekinumab [1,7].
Congress: Swiss Society of Dermatology and Venereology (SGDV)
Literature:
1st PracticeUpdate, www.practiceupdate.com/content/identifying-the-optimal-biologic-therapy-for-treatment-of-patients-with-psoriasis-at-the-individual-level/140755,(last accessed Jan. 26, 2023).
2 Gisondi P, et al: Treat-to-Target Approach for the Management of Patients with Moderate-to-Severe Plaque Psoriasis: Consensus Recommendations. Dermatol Ther (Heidelb) 2021; 11(1): 235-252.
3. van den Reek JMPA, et al: Drug Survival Studies in Dermatology:Principles, Purposes, and Pitfalls. J Invest Dermatol 2015; 135(7): 1-5.
4. “Controversies in psoriasis management,” Prof. Carle Paul, MD, SGDV Annual Congress, Nov. 09-11, 2022.
5 Yiu ZZN, et al; BADBIR Study Group: Drug Survival Associated With Effectiveness and Safety of Treatment With Guselkumab, Ixekizumab, Secukinumab, Ustekinumab, and Adalimumab in Patients With Psoriasis. JAMA Dermatol 2022; 158(10): 1131-1141.
6. Warren RB, et al: Differential drug survival of biologic therapies for the treatment of psoriasis: a prospective observational cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR) J Invest Dermatol 2015; 135(11): 2632-2640.
7 Nielsen ML, et al: Multivariable Predictive Models to Identify the Optimal Biologic Therapy for Treatment of Patients With Psoriasis at the Individual Level. JAMA Dermatol 2022; 158(10): 1149-1156.
8 Gisondi P, et al: Retention rate of systemic drugs in patients with chronic plaque psoriasis. Clin Dermatol 2013;1(1): 8-14.
9. Kerdel F, Don F: The importance of early treatment in psoriasis and management of disease progression. J Drugs Dermatol 2018;17(7): 737-742.
10. Menter A, et al: Drug survival of biologic therapy in a large, disease-based registry of patients with psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) J Eur Acad Dermatol Venereol 2016; 30(7): 1148-1158.
11 Arnold T, et al: Drug survival rates and reasons for drug discontinuation in psoriasis. J Ger Soc Dermatology 2016;14(11): 1090-1101.
12. Elnabawi YA, et al: Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovasc Res 2019; 115(4): 721-728.
13. von Stebut E, et al: Impact of secukinumab on endothelial dysfunction and other cardiovascular disease parameters in psoriasis patients over 52 weeks. J Invest Dermatol 2019; 139(5): 1054-1062.
DERMATOLOGIE PRAXIS 2023; 33(1): 24 (published 2/16/2013, ahead of print).
