Background and Importance Drug survival is defined as the time interval between treatment initiation and discontinuation. Several factors may influence drug survival such as efficacy, tolerability, and treatment adherence. Thus, drug survival can be used as a surrogate for treatment effectiveness. Biologics have changed the treatment paradigm in moderate to severe plaque psoriasis improving efficacy and tolerability.

Aim and Objectives We aimed to determine the 10-year drug survival for the biologics used in the treatment of moderate to severe plaque psoriasis where possible, in order to estimate real-world effectiveness and improve initial treatment decision making, considering biosimilar’s favourable costs.

Material and Methods All adult patients (aged 18–65 years) with a diagnosis of moderate to severe plaque psoriasis who initiated treatment with the following biologics between 28 February 2012 and 28 February 2022 (10 years) were included: adalimumab, brodalumab, certolizumab, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, and ustekinumab. Data were collected from pharmacy dispensing records and included a 6-month wash-out period before inclusion and a 1-year minimum follow-up for the last patient included. Data were censored, considering treatment discontinuation if no records were found in the last 3months of the follow-up period. Data were analysed using R statistical software.

Results A total of 1,353 patients were included (41.3% females, median-age 44 years). Only patients who initiated first-line adalimumab (n=124), etanercept (n=56) and ustekinumab (n=861) reached a 10-year treatment period. The 10-year drug survival (%, 95% confidence interval, n at risk) were: adalimumab (17.0, 10.2–28.3, n=5), etanercept (14.5, 6.74–31.1, n=2), ustekinumab (21.8, 18.1–26.3, n=29). Using adalimumab as reference, the Cox proportional hazard ratios for etanercept and ustekinumab were respectively: 0.90 (0.63–1.28, p=0.557) and 0.58 (0.46–0.72, p<0.001). Treating a patient for a 10-year period with biosimilar etanercept or ustekinumab cost an additional €46,033 or €84,504, respectively, comparing to biosimilar adalimumab.

Conclusion and Relevance A 10-year drug survival analysis was only available for adalimumab, etanercept and ustekinumab. Comparing to adalimumab, ustekinumab showed a significant higher 10-year drug survival (21.8 vs 17.0%, p<0.001). A strategy of switching from adalimumab to ustekinumab as soon as a biosimilar is available should be evaluated.

Conflict of Interest No conflict of interest.