IL-17 inhibitors more persistent than TNFs in both psoriasis, PsA

While biologic therapy persistence rates were generally low at 3 years, interleukin-17 inhibitors were generally more persistent than tumor necrosis factor inhibitors in both psoriasis and psoriatic arthritis, according to a study.

“Treatment options for psoriasis and psoriatic arthritis (PsA) have evolved significantly throughout the era of biologics,” Laura Pina Vegas, MD, MSc, of the department of epidemiology in dermatology and evaluation of therapeutics at Paris-East Créteil University in Créteil, France, and colleagues wrote.

The group suggested that clinical trials are “inadequate” to evaluate the relative long-term efficacy of biologics. In addition, trials fail to provide sufficient information regarding safety.

In the current nationwide cohort study, the researchers compared findings on biologics in the two diseases from the administrative health care database of the French health insurance scheme with the database for hospital discharges. The aim was to determine the long-term persistence of a number of drug classes.

All adults who had received a diagnosis of one of the two conditions who were new users of biologic therapies between Jan. 1, 2015, and May 31, 2019, were followed through Dec. 31, 2019. Individuals with psoriasis who were hospitalized for PsA and vice versa were excluded.

The main outcome of persistence was defined as the duration between initiation of biologic therapy to discontinuation.

The study included 16,892 patients with psoriasis (mean age, 48.5 years; standard deviation [SD], 13.8; 54.2% men). Tumor necrosis factor (TNF) inhibitors were initiated in 60.4% of these patients, while 23.6% received an interleukin (IL)-12/23 inhibitor and 16% received an IL-17 inhibitor.

The PsA cohort was comprised of 6,531 patients (mean age, 49.1 years; SD, 12.8; 45.4% men). The findings showed that 76.2% of the PsA cohort began with a TNF inhibitor, while 12.3% received an IL-12/23 inhibitor and 11.5% received an IL-17 inhibitor.

Overall, 3-year persistence rates of biologic therapies were 40.9% for psoriasis and 36.2% for PsA.

Adjusted analysis results showed that IL-17 inhibitors were more persistent compared with TNF inhibitors for both psoriasis (weighted HR = 0.78; 95% CI, 0.73-0.83) and PsA (wHR = 0.7; 95% CI, 0.58-0.85).

Also, IL-17 inhibitors were more persistent compared with IL-12/23 inhibitors for PsA (wHR = 0.69; 95% CI, 0.55-0.87). However, IL-17 inhibition was not more persistent than IL-12/23 inhibition for psoriasis.

IL-12/23 inhibitors were more persistent compared with TNF inhibitors in psoriasis (wHR = 0.76; 95% CI, 0.72-0.8) but not for PsA.

“Given the many biologic treatment options available in the modern therapeutic environment, our results may help physicians optimize first-line treatment pathways,” the researchers concluded. “However, the persistence rates of the three therapeutic classes remained low at 3 years, which suggests that long-term control of these chronic diseases may require several therapeutic lines.”