Predictors of Secukinumab Persistence Identified in Patients with Psoriasis

Pedro Mendes-Bastos, MD

A recent investigation into biologic therapy in patients with psoriasis detailed several predictors for secukinumab persistence including a time of diagnosis of 5 years or less, naïve biologic therapy status, and previous use of only 1 biologic.

Though biologic therapies such as secukinumab have changed the way psoriatic disease is managed in recent years, investigators suggested that drug monitoring was crucial in assessing the long-term safety and efficacy of these treatments.

Investigators led by Pedro Mendes-Bastos, MD, Dermatology Center at Hospital CUF Descobertas, Portugal, evaluated a sample of patients with psoriasis who were treated with secukinumab to better understand the persistence, efficacy, and real-world outcomes of the therapy in order to improve upon patient responses.

The team enrolled adult patients who were diagnosed with moderate to severe plaque psoriasis and started treatment with secukinumab between January 1, 2018 to January 1, 2020.

Persistence time for all eligible patients at 104 weeks was estimated via the Kaplan-Meier estimator and was defined as the time since secukinumab initiation until discontinuation or last medical contact.

Univariable and multivariable Cox regression models were adjusted to determine predictors of discontinuation.

Mendes-Bastos and colleagues evaluated a total of 302 patients, all of whom were followed for less than 3 months. Nearly half (41.7%) of the patient population was female, and the mean age was 48.4 years.

The mean time between diagnosis and treatment was 155 months, or 12.9 years. The median Psoriasis Area and Severity Index (PASI) score was 16.6 at baseline while the Nail Psoriasis Severity Index (NAPSI) score was 15.5.

Additionally, the median Dermatology Life Quality Index (DLQI) was reported as 16, and a familial history of psoriatic disease was 42.5%.

Regarding treatment history, 51.3% of all participants were bio-naïve while 48.7% had previously been exposed to biologic treatments. Furthermore, most bio-experienced patients (60.5%) had received only 1 biologic prior to the study, followed by 21.8% receiving 2 treatments, 13.6% receiving 3 and 4.1% receiving 4 treatments.

Ustekinumab was the most frequently used biologic.

Investigators observed that the overall treatment persistence was 71.7% at 104 weeks, with patients who initiated secukinumab treatment 5 or less years since their diagnosis having a significantly higher probability of drug persistence compared to those who initiated treatment within 5 or more years.

Following an exploratory analysis, investigators found that the patients were predominantly male (37.7% vs. 63.1%) (P<.001), and hadmorepsoriasis familyhistory (29.5% vs. 45.7%) (P=.023).

Additionally, these patients had less palmoplantar psoriasis (36.1% vs. 19.1%) (P=.005), and less DTLpsoriasis (91.8% vs. 80.5%) (P=.037).

Investigators hypothesized that a combination of these factors was responsible for higher persistence rates in this patient group.

Following a Cox regression model analysis, only 3 of the 5 potential predictors identified as significant in the univariable analysis were deemed impactful regarding secukinumab persistence.

Crucially, the results indicated that elapsed time following diagnosis to the initiation of treatment 5 or less years was positively associated with a higher probability of secukinumab continuation.

“These findings contrasts with data reported in the literature and deserves further investigation,” the team wrote.

The study, "Persistence, effectiveness, and real-world outcomes in psoriasis patients treated with secukinumab in Portugal," was published online in Dermatologic Therapy.