Guselkumab shows consistent drug survival in psoriasis

Compared with a number of other biologics used to treat psoriasis, guselkumab was associated with strong long-term drug survival as a function of both effectiveness and safety, according to study findings.

“Drug survival of biologic therapies for psoriasis is a proxy for longer-term treatment effectiveness and safety,” Zenas Z. N. Yiu, PhD, of the dermatopharmacology unit at the Salford Royal NHS Foundation Trust, and colleagues wrote.

They suggested that the survival of a biologic therapy may be contingent upon patient factors. In the current prospective cohort study, the group aimed to assess the survival associated with the effectiveness and safety of a number of drugs, including adalimumab (Humira, AbbVie), ustekinumab (Stelara, Janssen), secukinumab (Cosentyx, Novartis), guselkumab (Tremfya, Janssen) and ixekizumab (Taltz, Lilly).

Data for 16,122 treatment courses between November 2007 and August 2021 were culled from British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), according to the findings.

The study included 6,607 treatment courses initiated with adalimumab, 5,405 for ustekinumab, 2,677 for secukinumab, 730 for guselkumab and 703 for ixekizumab.

After 1 year of treatment, the crude survival function for measures of effectiveness was 0.81 (95% CI, 0.8-0.82) for adalimumab, 0.89 (95% CI, 0.88-0.89) for ustekinumab, 0.86 (95% CI, 0.85-0.87) for secukinumab, 0.94 (95% CI, 0.92-0.96) for guselkumab and 0.86 (95% CI, 0.83-0.89) for ixekizumab.

The researchers also calculated adjusted survival curves with a multivariate effectiveness model. Results of this analysis showed that compared with ustekinumab, guselkumab had the higher survival (adjusted HR = 0.13; 95% CI, 0.03-0.56) and adalimumab had the lower survival (aHR = 2.37; 95% CI, 2.03-2.76).

Similar survival curves were reported for secukinumab and ixekizumab over time, according to the findings.

Turning to patient modifiers of treatment effectiveness, the researchers noted that psoriatic arthritis, previous biologic exposure, nail involvement and ethnicity impacted survival.

Turning to the adverse event analysis, further findings showed a crude 1-year survival function for safety of 0.91 (95% CI, 0.9-0.91) for adalimumab, 0.94 for ustekinumab (95% CI, 0.94-0.95), 0.94 for secukinumab (95% CI, 0.92-0.94), 0.96 for guselkumab (95% CI, 0.94-0.98) and 0.92 for ixekizumab (95% CI, 0.89-0.94).

Similar adjusted survival curves were reported for guselkumab, ustekinumab and secukinumab. Compared with ustekinumab, adalimumab (aHR = 1.66; 95% CI, 1.46-1.89) and ixekizumab (aHR = 1.52; 95% CI, 1.13-2.03) had lower survival curves.

“The results of this cohort study suggest that guselkumab had the highest drug survival in BADBIR of the included biologics for treatment persistence that was associated with effectiveness, and guselkumab had highest drug survival for safety compared with other biologics except ustekinumab,” the researchers concluded. “This information on longer-term treatment persistence, safety and tolerability may help patients and their clinicians make an informed decision to initiate treatment with a biologic therapy.”