Guselkumab, Risankizumab Boast Longest Drug Survival Among IL-17, IL-23 Inhibitors

Juul van den Reek, MD, PhD
Credit: International Psoriasis Council

Guselkumab and risankizumab had the highest rates of drug survival in patients with psoriasis among IL-17 and IL-23 inhibitors, according to the results of a new study.

A systematic review and meta-analysis of 69 studies with more than 48,000 participants, results indicate the IL-17 and IL-23 inhibitors examined in the study, which included secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, and tildrakizumab, exhibited high drug survival rates, with the greatest rates observed with guselkumab and risankizumab.¹

“A review and meta-analysis on the drug survival of the newer biologics (IL-17 and IL-23 inhibitors) are not yet available,” wrote investigators.¹ “The advanced methodology used in this meta-analysis summarised the total course of drug survival curves. This provides more robust and precise summary drug survival estimates that enhance the reliability of findings. For patient-tailored treatment, a comprehensive overview of the newer biologics is essential in making evidence-based choices among the newer biologics available for psoriasis.”

In the 9 years since secukinumab received approval as the first IL-17 inhibitor for the treatment of psoriasis, dermatology has seen a flood of new therapies, including the first IL-23 inhibitor approval. In this time, agents in these classes have become cornerstones of management for patients with psoriasis. However, with such a riches of biologic therapies, dermatologists and dermatology care providers have to make individualized decisions surrounding treatment choices for patients.^2,3

With this in mind, a team of investigators led by Juul van den Reek, MD, PhD, of the Department of Dermatology at Radboud University Medical Centre, launched the current research endeavor to provide clarity into these discussions. Along with colleagues from Radboud University Medical Center, investigators performed a search of PubMed, Emboss, Cochrane Library, and Web of Science databases from inception through December 27, 2023 for cohort studies of patients aged 18 years or older with plaque psoriasis evaluating drug survival of at least 1 of the aforementioned IL-17 and IL-23 inhibitors.¹

Among the 69 studies included, 47 reported on secukinumab (23,960 patients), 31 on ixekizumab (12,446 patients), 13 on brodalumab (2353 patients), 24 on guselkumab (8174 patients), 7 on risankizumab (1427 patients), and 4 on tildrakizumab (304 patients).¹

Results of the investigators’ analysis revealed summary drug survival estimates (SSE) of registry/electronic health record studies for overall, ineffectiveness and adverse event related drug survival were high (all point estimates ≥ 0.8 at year 1) for included biologics, with highest estimates for guselkumab and risankizumab. Highlights from the direct comparison of SSEs are listed below:¹

Guselkumab:¹

• Statistically significantly greater SSE for overall drug survival at years 2 and 3 compared with secukinumab and ixekizumab.
• Higher rates at years 1, 2, and 3 for ineffectiveness-related drug survival compared with secukinumab.
• Estimated differences and 95% CIs:
• Secukinumab vs guselkumab: −0.15 (95% CI, −0.25 to −0.04) at year 2, and −0.24 (95% CI, −0.40 to −0.08) at year 3.
• Ixekizumab vs guselkumab: −0.13 (95% CI, −0.27 to −0.00) at year 2, and −0.16 (95% CI, −0.31 to −0.00) at year 3.
• Secukinumab vs guselkumab for ineffectiveness-related drug survival: −0.06 (95% CI −0.11 to −0.01) at year 1, −0.16 (95% CI, −0.23 to −0.09) at year 2, and −0.25 (95% CI, −0.36 to −0.15) at year 3.

Risankizumab:¹

• Statistically significantly greater SSE for overall drug survival at years 1, 2, and 3 compared with secukinumab and ixekizumab.
• Higher rates at year 2 and 3 compared with brodalumab.
• Estimated differences and 95% CIs:
• Secukinumab vs risankizumab: −0.11 (95% CI −0.17 to −0.04) at year 1, −0.22 (95% CI −0.32 to −0.12) at year 2, and −0.33 (95% CI, −0.49 to −0.17) at year 3.
• Ixekizumab vs risankizumab: −0.12 (95% CI −0.21 to −0.03) at year 1, −0.21 (95% CI −0.33 to −0.08) at year 2, and −0.24 (95% CI, −0.39 to −0.10) at year 3.
• Brodalumab vs risankizumab : −0.17 (95% CI −0.34 to −0.00) at year 2, and −0.23 (95% CI −0.44 to −0.02) at year 3.

Investigators noted multiple limitations within their study to consider when interpreting results. These included being limited to English-language publication, lack of drug survival studies reporting on bimekizumab, only having short-term follow-up drug survival data for tildrakizumab, and the fact that several discontinuation reasons underlie the outcome of drug survival.¹

References:

1. Thomas SE, Barenbrug L, Hannink G, Seyger MMB, de Jong EMGJ, van den Reek JMPA. Drug Survival of IL-17 and IL-23 Inhibitors for Psoriasis: A Systematic Review and Meta-Analysis. Drugs. Published online April 17, 2024. doi:10.1007/s40265-024-02028-1
2. Fala L. Cosentyx (Secukinumab): First IL-17A Antagonist Receives FDA Approval for Moderate-to-Severe Plaque Psoriasis. Am Health Drug Benefits. 2016;9(Spec Feature):60-63.
3. Boehncke WH, Brembilla NC, Nissen MJ. Guselkumab: the First Selective IL-23 Inhibitor for Active Psoriatic Arthritis in Adults. Expert Rev Clin Immunol. 2021;17(1):5-13. doi:10.1080/1744666X.2020.1857733