Author(s): Warren R., Smith C., Yiu Z., Ashcroft D., Barker J., Burden D., Lunt M., McElhone K., Ormerod A., Owen C., Reynolds N., Griffiths C.E.M.
Abstract: Persistence with therapy is a surrogate marker of drug effectiveness, safety and tolerability. We assessed the persistence of four biologics used to treat psoriasis in a large prospective pharmacovigilance cohort (British Association of Dermatologists' Biologic Interventions Register, BADBIR) in the U.K. and Ireland. Persistence rates for the first course of biologics for 3523 biologicnaive patients with chronic plaque psoriasis were compared, using survival analysis techniques, from a data extract up to August 2014. An a priori list of baseline covariates was deter mined to address potential predictors of discontinuation. These were analysed using multivariate Cox proportional hazard models for discontinuations: (i) overall, (ii) due to ineffectiveness and (iii) due to adverse events. Data for patients on adalimumab (n = 1879), etanercept (n = 1098), infliximab (n = 96) and ustekinumab (n = 450) were available. The median (interquartile range) duration of follow-up for patients receiving adalimumab was 1.3 (1.6) years, etanercept 1.5 (2.0) years, infliximab 1.2 (1.6) years and ustekinumab 1.2 (0.9) years. The overall persistence rate in the first year for adalimumab was 79%, etanercept 70%, infliximab 65% and ustekinumab 89%. Ustekinumab had the lowest first-year discontinuation rate due to ineffectiveness (4%) and adverse events (4%), while etanercept had the highest first-year discontinuation rate due to ineffectiveness (20%) and infliximab had the highest first-year discontinuation rate due to adverse events (16%). Multivariate analysis for discontinuations overall showed that female sex [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.09- 1.37], being a current smoker (HR 1.19, 95% CI 1.03-1.38) and a higher baseline Dermatology Life Quality Index (HR 1.01, 95% CI 1.00-1.02) were predictors of discontinuation, while having psoriatic arthritis (HR 0.82, 95% CI 0.71-0.96) was a predictor for persistence. Overall, compared with adalimumab, patients on etanercept (HR 1.63, 95% CI 1.45-1.84) or infliximab (HR 1.56, 95% CI 1.16-2.09) were more likely to discontinue therapy, while patients on ustekinumab were more likely to persist with therapy (HR 0.48, 95% CI 0.37-0.62). Patients on ustekinumab were also more likely to continue therapy compared with those on adalimumab in the models for discontinuation due to ineffectiveness (HR 0.37, 95% CI 0.25-0.57) and for adverse events (HR 0.60, 95% CI 0.39-0.92). After accounting for relevant covariates, ustekinumab had the highest overall persistence with therapy and adalimumab had the highest persistence with therapy among the tumour necrosis factor inhibitors. These data, derived from the largest published independent dataset, involving 151 dermatology centres in the U.K. and Ireland, may contribute to the decision-making process when choosing treatment for biologic-naive patients with psoriasis. BADBIR receives funding from Pfizer, Janssen and AbbVie. Decisions concerning analysis and interpretation are made autonomously of any industrial contribution.
Conference Information: 95th Annual Meeting of the British Association of Dermatologists Manchester United Kingdom. Conference Start: 20150707 Conference End: 20150709
Publisher: Blackwell Publishing Ltd
Publication Type: Journal: Conference Abstract