Persistence of Treatment with Secukinumab and Ixekizumab in Patients with Moderate to Severe Psoriasis
Although IL-17 targeted drugs are increasingly used in the treatment of moderate to severe psoriasis, we currently have limited data on patient persistence with these treatments.
Differences Between Real-world Practice and Clinical Trials
Clinical trials have shown that IL-17 targeted drugs have better efficacy compared to tumor necrosis factor alpha inhibitors. However, real-world practice data analyses have suggested shorter than expected treatment persistence with the IL-17 inhibitor secukinumab, indicating that its real-world efficacy may differ from clinical trial findings. One possible explanation is that in practice, secukinumab is often used for patients who have already failed several lines of other biologic therapies.
Evaluated Population
Researchers from the University of Copenhagen aimed to verify this hypothesis through an analysis of data on patients treated with IL-17 inhibitors secukinumab (SEC) and ixekizumab (IXE) in routine clinical practice. The data were obtained from the nationwide DERMBIO registry, which contains information about patients with moderate to severe plaque psoriasis treated with biological therapies at standard doses. Danish dermatologists prescribing this targeted therapy are required to enter their patients into this database.
The analysis included data from 368 patients on SEC and 62 on IXE. Among those treated with SEC, 40.7% had no prior targeted biological therapies, compared to 12.9% of those treated with IXE. Among biologically pre-treated patients, those in the IXE group had significantly more prior types of biological therapies on average (SEC 2.3 and IXE 4.1).
Results
Among biologically naïve patients, 23.5% on SEC discontinued treatment prematurely within 12 months of follow-up, and none on IXE. Treatment persistence was shorter for SEC compared to IXE both among biologically naïve and previously treated patients. The 3-year follow-up analysis revealed that SEC persistence was shortest in patients who had undergone treatment with ≥ 2 biologics and in those for whom SEC was the second biologic therapy. The main reason for discontinuation in the overall population was primarily insufficient efficacy, followed by adverse treatment effects.
Conclusion and Discussion
In routine Danish clinical practice, longer persistence with IXE compared to SEC was observed, despite IXE patients being significantly more pre-treated with previous biological therapies. The reason for this could be different affinities of the drugs to IL-17. A limiting factor of this study could be the small number of participants and the short follow-up period; nevertheless, this is the largest cohort of psoriasis patients taking SEC or IXE in real clinical practice to date.
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Source: Egeberg A., Bryld L. E., Skov L. Drug survival of secukinumab and ixekizumab for moderate-to-severe plaque psoriasis. J Am Acad Dermatol 2019; 81 (1): 173–178, doi: 10.1016/j.jaad.2019.03.048.
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