Biologic Drug Survival in Psoriasis: A Systematic Review & Comparative Meta-Analysis

Abstract

ABSTRACTBackgroundDrug survival studies have been utilized to evaluate the real-world effectiveness of biologics used in psoriasis. However, the increasing volume of drug survival data suffers from large variability due to regional differences in drug availability, patient selection and biologic reimbursement.ObjectivesTo conduct a meta-analysis of biologic drug survival to determine comparative effectiveness of the biologics in a real-world setting.MethodsStudies reporting drug survival for biologic therapy in psoriasis were identified by a systematic literature search. Hazard ratio data for drug discontinuation were estimated directly from published Kaplan-Meier estimator curves at year 1, 2 and 5 of treatment and compared pairwise for the following biologics: ustekinumab, adalimumab, etanercept, infliximab, secukinumab and ixekizumab. This pooled hazard ratios were used to estimate 2- and 5-year overall drug survival rates.ResultsUstekinumab had the longest persistence at 2 years and 5 years among all biologics included in this meta-analysis. Adalimumab was superior to etanercept and infliximab at 5 years. Pooled 5-year drug survival rates for adalimumab, etanercept, and infliximab were 46.3%, 35.9% and 34.7%, respectively. 2- and 5-year data were not available for anti-IL-17 drugs, but at 1-year ustekinumab outperformed secukinumab, the latter being equal to anti-TNFs.ConclusionsUstekinumab is characterized by longer drug survival than TNF inhibitors and IL-17 inhibitors. Estimated pooled 2- and 5-year drug survival rates may serve as a useful tool for patient communication and clinical decision-making.