The impact of the release of new biologic treatments for psoriasis on discontinuation of existing treatment

Linked Article:   Graier et al. Br J Dermatol 2021; 184 :1094–1105. Biologics (drugs injected under the skin) have revolutionized the treatment of moderate‐to‐severe plaque psoriasis. However, it is well known that these drugs perform differently under real‐life conditions than in clinical trials, in terms of skin improvement, safety and ‘drug survival’ (the length of time until discontinuation of a drug). These issues can be influenced by both factors relating to the patient and the disease; however, it was unknown if the introduction of new biologic agents over time can have an influence on drug survival. We analysed data from the Psoriasis Registry Austria (PsoRA) and included 1572 patients who received 1848 treatments with biologic agents (adalimumab, etanercept, ixekizumab, secukinumab or ustekinumab). We wanted to study the impact that sex, psoriatic arthritis, previous biologic treatment and the release of new antipsoriatic drugs [secukinumab and ixekizumab, which block the inflammatory activity of a chemical cytokine called interleukin (IL)‐17] had on drug discontinuation. We found that previous biologic treatment and female sex significantly increased the risk for drug discontinuation among all drugs. Although no significant influence of psoriatic arthritis was observed, the introduction of the new IL‐17 inhibitors increased the likelihood of discontinuation of treatment among patients treated with various biologic agents. This study provides important evidence for physicians, as the availability of new therapeutic agents should be considered when analysing and comparing drug survival. Furthermore, it shows that women and patients who have received previous biologic treatment are more likely to stop treatment.