Drug survival of guselkumab and risankizumab seems superior to other biologics

An analysis from the BADBIR registry showed that the IL-23p19 inhibitors guselkumab and risankizumab showed the highest drug survival in both effectiveness and safety. Regarding safety, ustekinumab had a similar drug survival to the agents mentioned above.

The IL-23p19 inhibitor risankizumab proved to be efficacious and had a good safety profile in randomised clinical trials. However, data on its effectiveness and safety in the real-world daily clinical practice setting is scarce [1]. This was the rationale for assessing the real-world outcome of this agent in a daily clinical practice setting. “Drug survival acts as a proxy marker for treatment effect and safety,” explained Dr Zenas Yiu (University of Manchester, UK) [2]. Only a few small studies reported on the real-world drug survival of brodalumab and risankizumab. Therefore, Dr Yiu and his team conducted a cohort study using the BADBIR, a national pharmacovigilance registry including patients with psoriasis from the UK and the Republic of Ireland, with data collected between November 2007 and June 2023.

The analysis included 19,043 treatment courses from 11,877 participants with a median follow-up time of 2.3 years. The older biologics had larger cohorts, whereas newer treatments had smaller cohorts with shorter follow-up times. Most participants were treated with adalimumab (n=6,815), followed by ustekinumab (n=5,639). A further 832 participants were treated with risankizumab and 1,258 with guselkumab.

Therapy with the IL-23p19 inhibitors had the highest survival time with respect to effectiveness (guselkumab adjusted HR 0.28; 95% CI 0.15–0.53; risankizumab aHR 0.38; 95% CI 0.16–0.87), whereas adalimumab showed a lower survival compared with all other biologics (aHR 1.98; 95% CI 1.76–2.23). Biologics targeting IL-17 had similar drug survival earlier and lower drug survival later in follow-up compared with ustekinumab. Regarding safety, the longest restricted mean survival times were seen with p19 inhibitors and ustekinumab (see Table).

Table: Restricted mean survival time (RMST) at 2 years [2]



Dr Yiu emphasised that the current study included the largest cohort of psoriasis patients on IL-23p19 inhibitors reported thus far. It showed that people with psoriasis persist with IL-23p19 inhibitors for up to an estimated 21 weeks longer for effectiveness and 13 weeks longer for safety compared with other biologics over 2 years on average. “These results may be valuable when discussing treatment choices where the patients value treatment effect longevity,” Dr Yiu concluded.

1. 
   
   1. Gordon KB, et al. Lancet 2018;392:650­–61.
   2. Yiu Z. Drug survival of interleukin-23 p19 inhibitors compared to other biologics for psoriasis: a cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). D1T01.1K, EADV Congress 2023, 11–14 October, Berlin, Germany.

 

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Posted on 28 November, 202322 February, 2024