This study represents the first comprehensive evaluation of real-world drug survival for IL-23p19 and IL-17 inhibitors in psoriasis treatment, revealing longer treatment duration for IL-23 inhibitors in terms of both efficacy and safety.
Literature Overview
The article titled 'Drug survival of IL-23 and IL-17 inhibitors versus other biologics for psoriasis: A British Association of Dermatologists Biologics and Immunomodulators Register cohort study', published in the Journal of the European Academy of Dermatology and Venereology, reviews and summarizes drug survival outcomes of multiple biologics for psoriasis treatment, with particular focus on the newer IL-23p19 and IL-17 inhibitors. Through large-scale cohort data from the UK and Ireland, this study systematically evaluates the durability of these drugs in real-world clinical settings.
Background Knowledge
Psoriasis is a chronic autoimmune-mediated inflammatory skin disease that can progress to psoriatic arthritis (PsA) in some patients, severely impacting quality of life. Tumor necrosis factor α (TNF-α) inhibitors, IL-17A inhibitors, and IL-23p19 inhibitors currently serve as primary biologics for moderate-to-severe psoriasis. While randomized controlled trials (RCTs) demonstrate superior efficacy of IL-23 and IL-17 inhibitors compared to earlier biologics, real-world data remain limited, particularly for risankizumab and brodalumab. This study aims to fill this knowledge gap through large-scale cohort analysis, providing clinicians critical reference information for treatment selection.
Research Methods and Experiments
The research team utilized the British Dermatological Biologics Register (BADBIR) cohort data, incorporating 19,034 treatment episodes to evaluate drug survival duration defined as the time from treatment initiation to discontinuation exceeding 90 days. Flexible parametric models (FPM) were employed to assess drug survival, with separate analyses conducted for discontinuations due to inefficacy or adverse reactions. Multivariable adjusted models analyzed drug persistence across subgroups including psoriatic arthritis patients and prior biologic-exposed individuals.
Key Conclusions and Perspectives
Research Significance and Prospects
This study provides the first systematic comparison of IL-23 and IL-17 inhibitors' drug survival in a large real-world cohort, offering robust evidence to support IL-23p19 inhibitors as first-line therapy. Future research should further investigate long-term efficacy and safety profiles of different drugs in specific subpopulations to optimize personalized treatment strategies.
Conclusion
Through BADBIR cohort analysis, this study systematically evaluated drug survival of IL-23p19 and IL-17 inhibitors for psoriasis treatment. Results demonstrate that guselkumab and risankizumab exhibit superior performance in both efficacy and safety, supporting their selection as preferred long-term therapeutic options. While brodalumab shows shorter efficacy survival, its safety profile matches other IL-17A inhibitors. The findings highlight PsA status and prior treatment exposure as critical factors affecting drug persistence, providing essential reference points for clinicians developing individualized treatment strategies. These insights hold significant implications for optimizing biologic selection and treatment paradigms in psoriasis management.
