IL-17 Inhibitors Associated with High Treatment Persistence in Psoriasis Patients

Pascal Claudepierre, MD, PhD

A new investigation from France found that interleukin-17 (IL-17) inhibitors were associated with higher treatment persistence in patients with psoriasis and psoriatic arthritis than TNF inhibitors.

Interleukin-17 inhibitors were also associated with higher persistence than IL-12 and IL-23 inhibitors for PsA, though no difference was observed for psoriasis. Furthermore, the persistence rates for all biologics were globally low at 3 years.

Investigators led by Pascal Claudepierre, MD, PhD, Department of Rheumatology at Henri Mondor Hospital, Créteil, noted that the topic of treatment persistence has piqued the interest of many dermatologists and rheumatologists in recent years.

Despite this, existing studies have been limited by several factors including selective recruitment, low patient numbers, and lack of data on recently marketed biologics.

As such, Claudpierre and colleagues estimated the persistence of first-line biologics for psoriasis and PsA and compared persistence across different therapeutic classes.

The Methods

The large, nationwide cohort study was based on an analyses of the French National Health Insurance database called the Système National des Données de Santé, which covered over 66 million individuals. The database contained individualized outpatient health data sec as birth, sex, and vital status as well as public and private hospitalization data.

All adults 18 years or older with psoriasis or PsA who were registered in the database were eligible for inclusion from January 1, 2015, to May 31, 2019.

Adult patients with psoriasis were identified by the reimbursement of at least 2 topical vitamin D derivatives while adults with PsA were identified with a specific ICD-10 code. Patients who were hospitalized in the year before the index date for PsA from the psoriasis cohort were excluded from the study, as were those who did not maintain treatment for at least 6 months.

Biologic agents featuted in the study included the TNF inhibitors etanercept, infliximab, adalimumab, certolizumab, and golimumab; the IL-12/23 inhibitor ustekinumab; and the IL-17 inhibitors secukinumab, ixekizumab, and brodalumab.

The Findings

A total of 16,892 patients with psoriasis were included in the analysis, with a mean age of 48 years.

Of these, 10,199 patients (60.4%) started therapy with a tumor necrosis factor (TNF) inhibitor, 3982 (23.6%) with an IL-12 and IL-23 inhibitor, and 2711 (16.0%) with an IL-17 inhibitor.

Pregarding patients with PsA, a total of 6531 patients were included. Among these patients, 4974 (76.2%) started therapy with a TNF inhibitor, 803 (12.3%), with an IL-12/23 inhibitor, and 754 (11.5%), with an IL-17 inhibitor.

Overall investigators observed that 3-year persistence rates were 40.9% and 36.2% for PsO and PsA, respectively.

Following inverse probability of treatment weighing and adjustment, the IL-17 inhibitor was associated with higher persisitence when compared to the TND inhibitor for psoriasis (weighted hazard ratio [HR], 0.78 [95% CI, 0.73-0.83]) and PsA (weighted HR, 0.70 [95% CI, 0.58-0.85]) and compared with the IL-12/23 inhibitor for PsA (weighted HR, 0.69 [95% CI, 0.55-0.87]).

Additionally, the IL-12/23 inhibitor was associated with higher persistence than the TNF inhibitor for PsO (weighted HR, 0.76 [95% CI, 0.72-0.80]), with no difference observed for PsA.

Investigators believed these results could aid physicians in optimizing first-line treatment pathways.

“However, the persistence rates of the 3 therapeutic classes remained low at 3 years, which suggests that long-term control of these chronic diseases may require several therapeutic lines,” the team wrote.

The study, "Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database," was published online in JAMA Dermatology.