PsoBest registry: Biologics dominate treatment for moderate-to-severe psoriasis

A comprehensive review of the PsoBest registry highlights the rise of biologics as the preferred therapy for moderate-to-severe psoriasis. This change marks a significant evolution in treatment strategies over 15 years, favouring modern, more effective approaches.

Over the last 2 decades, the supply of systemic drugs for psoriasis has undergone an unprecedented dynamic (see Figure) [1]. The German Psoriasis Registry, PsoBest, evaluates clinical outcomes, safety, and use of systemic drugs for psoriasis and psoriatic arthritis in Germany. The registry includes more than 90% of the prescribers of biologics in Germany. Data from the registry was used to examine how the change in drug supply influenced the use of systemic therapeutics in psoriasis patients.

Figure: Inventions of systemic antipsoriatic drugs in Europa/Germany from 2004 to 2024 [1]



 

 

 

 

 

 

 

 

 

 

DMF, dimethyl fumarate; PsA, psoriatic arthritis; Pso, psoriasis.

Between 2008 and 2023, the PsoBest registry analysed 16,293 patients with a mean age of 47.6 years, 58.2% of whom were men. In total, 18.8% suffered from psoriatic arthritis and 46.8% from nail psoriasis.

Over this period, the proportion of non-biologics included fell from 67.7% to 13.5%. To the same extent, more biologics were used for registry reporting, reflecting advancements in biologic therapies and their growing role in clinical practice. The most frequently pre-exposed non-biological systemic therapeutics were fumaric acid esters (20.8% on average) and methotrexate (20%). Particularly, a dramatic rise was seen in the proportion of biologics given as first systemic therapy from 1.5% in 2008 to 32.8% in 2023.

The registry data further mirrors the progression of biological classes over time. From 2008 to 2015, TNF inhibitors, such as adalimumab, were the most frequently prescribed class. From 2015 to 2018, IL-17 antagonists, such as secukinumab, became more prominent, followed by IL-23 inhibitors, the leading drug class since 2019. This data is supported by that from the statutory health insurance companies in Germany.

Despite these advancements, challenges remain. Patients with multiple prior systemic therapies still demonstrate a diminishing therapeutic response over time, highlighting the need for continued innovation and personalised treatment approaches.

The dynamic shift towards biologics reflects significant progress in psoriasis treatment and mirrors the development of new drug classes. Registries such as PsoBest are a valuable amplifier of the use of innovations for psoriasis.

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   1. Augustin M. Drug supply for psoriasis in transition: 15 years of experience in the German Psoriasis Registry PsoBest. EPS02.08, EADV Congress 2024, 25–28 September, Amsterdam, the Netherlands.

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Posted on 6 November 20247 November 2024