Ixekizumab Improves Retention vs Secukinumab in Patients With Psoriasis

Ixekizumab may better improve treatment adherence and lower discontinuation and switching rates compared with secukinumab in biologic-experienced patients with psoriasis, according to study findings published recently in Dermatology and Therapy.

Although continuous treatment with biologics is recommended to achieve effective disease management in patients with psoriasis, approximately 18% to 46% of patients in real-world settings discontinue their biologic therapy within the first year of treatment.

Notably, biologic-experienced patients have been associated with poor anticipated biologic treatment efficacy and subsequent risk of symptom recurrence. Newer interleukin (IL)-17A inhibitors of ixekizumab, secukinumab, and brodalumab have conversely demonstrated high efficacy among these populations.

“Clinical trials indirectly indicate that ixekizumab and secukinumab show comparable efficacy irrespective of their prior biologic use in patients with psoriasis; however, head-to-head comparisons are lacking in clinical trials and limited in real-world settings,” said the study authors.

Seeking to compare the persistence, adherence, discontinuation, reinitiation, and switching rates between the 2 biologics, they conducted a retrospective observational study with over 18 months of follow-up among biologic-experienced patients with psoriasis treated with either ixekizumab (n = 411) or secukinumab (n = 780) in a real-world setting.

The study assessed administrative claims data derived via IBM Watson Health MarketScan Research Databases on adult patients with 1 or more inpatient or 2 or more nondiagnostic (≥ 30 days apart) outpatient claims with a diagnosis of psoriasis between March 1, 2015, and October 31, 2019, and 1 or more claims for the index drugs, ixekizumab or secukinumab, between March 1, 2016, and October 31, 2019.

Moreover, biologic-experienced patients were noted as those who had 1 or more claims for biologics indicated for psoriasis in the 6-month preperiod. Both patient groups were compared for treatment adherence (proportion of days covered [PDC]), high adherence (PDC ≥ 80%), persistence, discontinuation, reinitiation, and switching during the 18-month follow-up.

“To address cohort imbalances, inverse probability of treatment weighting was employed,” added the study authors.

In the weighting-adjusted findings, biologic-experienced patients with psoriasis given ixekizumab exhibited significantly improved treatment outcomes vs those given secukinumab:

• High treatment adherence: 42% vs 35% (P = .019)
• Higher persistence rate: 44.9% vs 36.9% (P = .007)
• Lower discontinuation rate: 48.4% vs 56.0% (P = .012)
• Lower switching rate: 26.6% vs 34.0% (P = .009)
  

Furthermore, multivariable-adjusted analysis findings supported these trends, with patients administered ixekizumab associated with 36% higher odds of high treatment adherence (OR, 1.36; 95% CI, 1.05-1.74), 20% lower risk of treatment nonpersistence (HR, 0.80; 95% CI, 0.68-0.93), 19% lower risk of discontinuation (HR, 0.81; 95% CI, 0.68-0.96), and 25% lower risk of switching (HR, 0.75; 95% CI, 0.60-0.93) compared with those given secukinumab.

“These results add to existing data by providing comparative evidence that biologic-experienced patients treated with ixekizumab are more likely to remain on treatment longer and use medication more persistently compared to patients treated with secukinumab,” concluded the study authors. “These findings generated from real-world clinical settings could aid health care providers in making treatment decisions for biologic-experienced patients with psoriasis.”

Reference

Blauvelt A, Shi N, Burge R, et al. Comparison of real-world treatment patterns among biologic-experienced patients with psoriasis treated with ixekizumab or secukinumab over 18 months. Dermatol Ther (Heidelb). Published online October 15, 2021. doi:10.1007/s13555-021-00627-4