Lower Risk of Biologic Discontinuation Found With Ustekinumab Use in Psoriasis

Ustekinumab was associated with a lower risk of discontinuation vs other biologics in the treatment of moderate to severe psoriasis, according to study findings published recently in Dermatology and Therapy.

Although several FDA-approved biologics have shown efficacy and safety in the management of moderate to severe psoriasis, drug survival for these therapies has been noted to be a significant issue marked by frequent discontinuation rates and poor adherence, which can lead to inferior health outcomes.

“Lack of compliance may be due to a number of factors, including drug tolerability, convenience, cost, and effectiveness, and overall patient satisfaction with treatment,” said the study authors.

“Compared with other biologics, ustekinumab has been associated with lower rates of discontinuation and better adherence among patients with psoriasis," they added, "but prior studies have included limited data from the period after approval of self-administration for ustekinumab.”

In seeking to further investigate the risk of discontinuation among patients with psoriasis initiating ustekinumab and other FDA-approved biologics, they conducted a retrospective cohort study of data from Optum’s de-identified Clinformatics Data Mart database (January 1, 2010, to June 30, 2019). Adult patients with psoriasis who had 1 or more claim(s) for ustekinumab, secukinumab, adalimumab, or ixekizumab were included in the study (mean age, 49.0 years; 49.3% female for all cohorts).

Treatment discontinuation was defined as a gap in days of therapy supply based on each drug’s per-label frequency of administration (main analysis) or a duration beyond 90 days (sensitivity analysis). Treatment adherence and switching patterns among these agents were also evaluated.

“Adherence to the index biologic was described using the proportion of days covered (PDC). PDC was defined as the sum of nonoverlapping days of supply of the index agent divided by a fixed period (ie, 3, 6, 12, 18, and 24 months) among patients followed for at least the same fixed duration of time.”

In total, 2230 patients were included in the ustekinumab, 1807 in the secukinumab, 4483 in the adalimumab, and 535 in the ixekizumab cohorts. In the main analysis, risk of discontinuation for the ustekinumab cohort was 62.2% lower than for the adalimumab, 46.4% lower than for the secukinumab, and 43.8% lower than for the ixekizumab cohorts (all P < .001). Sensitivity analyses revealed no significant differences between the ustekinumab and other cohorts.

Regarding treatment adherence, the mean PDC was similar across all assessed biologics after 3, 6, 12, 18, and 24 months of follow-up, with the PDC for ustekinumab trending higher over time. The proportion of patients with a PDC of 0.8 or greater also appeared higher in the ustekinumab cohort compared with the adalimumab and ixekizumab cohorts at 6, 12, and 18 months of follow-up.

As for switching patterns based on the discontinuation gap of more than 1 time the per-label frequency of administration, 28.2%, 40.5%, 47.2%, and 35.9% of patients in the ustekinumab, secukinumab, adalimumab, and ixekizumab cohorts, respectively, switched to a new psoriasis-related treatment within the first 24 months of follow-up (mean time to switch, 9.1, 8.3, 7.1, and 8.0 months, respectively).

“These results may help inform the choice of biologic therapy based on compliance, which may subsequently improve outcomes of patients with psoriasis,” concluded the study authors.

Reference

Pilon D, Fitzgerald T, Zhdanava M, et al. Risk of treatment discontinuation among patients with psoriasis initiated on ustekinumab and other biologics in the USA. Dermatol Ther (Heidelb). Published online March 19, 2022. doi:10.1007/s13555-022-00707-z