Secukinumab was associated with a high rate of short- and long-term drug survival in the treatment of patients with psoriasis, with factors such as obesity and prior biologic use linked to discontinuation of use.
Constructed as a fully human monoclonal IgG1/j isotype antibody that selectively binds to and neutralizes the proinflammatory cytokine interleukin 17A, secukinumab has been shown to be highly effective and safe in the treatment of moderate-to-severe plaque psoriasis, as well as in axial spondyloarthritis and psoriatic arthritis (PsA).
However, researchers noted that there is limited and conflicting evidence in regard to the real-world drug survival of secukinumab in patients with psoriasis, particularly in the long term.
“There is also a great variability in the results related to the predictors of a greater or lesser survival,” they added.
Seeking to address these gaps in knowledge pertaining to short- and long-term survival of secukinumab and its predictive factors for the treatment of psoriasis, they conducted a restrospective, multicenter study of data derived from a nationwide cohort of patients with plaque psoriasis undergoing secukinumab treatment in Spain (N = 384; mean [SD] age, 47.6 [12.5] years; 30% presented with PsA).
Participants of 20 Spanish hospitals were followed up for a period of 2 years between February 2014 and March 2018, in which monitoring of secukinumab treatment was performed at baseline, 1, 3, 6, 12, 18, and 24 months after the therapy start date.
Predictive factors for retention on secukinumab treatment among patients with psoriasis included incidence of obesity (body mass index ≥ 30), whether a patient was biologically experienced (≥ 2 biologics) or naive, and severity of psoriasis, measured via Psoriasis Area Severity Index (PASI) at less than 10 or at least 10 (severe).
At baseline, 278 patients (72.4%) were indicated to have severe plaque psoriasis (median [SD] baseline PASI, 14.3 [8.4]), 42.6% were obese, and the proportion of naive and biologically experienced patients was 31% and 49%, respectively.
Overall, the observed cumulative drug survival rates at 6, 12, 18, and 24 months were 97.1%, 89.0%, 81.1%, and 74.3%, respectively. Researchers highlighted that findings were consistent with those described in a prior meta-analysis and were “remarkably higher than those previously reported by multicenter studies in the Netherlands and Denmark.”
In assessing discontinuation of secukinumab treatment, 83 (21.6%) discontinued the treatment at different moments of the study due to drug ineffectiveness (16.7%), adverse effects (3.4%), or patient decision (1.6%).
Based on the predictive factors examined, a significantly increased risk of secukinumab discontinuation was found in patients with obesity (HR, 1.809; 95% CI, 1.114-2.962; P = .004) and those with prior experience with anti–tumor necrosis factor (TNF) and anti–interleukin 12/23 biologic therapies (HR, 3.476; 95% CI, 1.875-6.444; P = .017).
Furthermore, patients with PsA were associated with delayed discontinuation (HR, 0.493; 95% CI, 0.265-0.917; P = .025). No significant difference in drug survival rates was shown between the group of patients with severe plaque psoriasis (PASI ≥ 10) and those without severe disease (PASI < 10) at baseline.
Daudén E, Gomes de Lima GP, Armesto S, et al. Multicenter retrospective study of secukinumab drug survival in psoriasis patients in a daily practice setting: a long-term experience in Spain. Dermatol Ther (Heidelb). Published online September 24, 2021. doi:10.1007/s13555-021-00606-9