Revealing patient characteristics and treatment outcomes among ultra-long users of biologics for psoriasis
Authors: Henckens Nikki F T , Otero Marisol E , van den Reek Juul M P A , de Jong Elke M G J ,   the BioCAPTURE network, Keijsers Romy R M C , van Lümig Paula P M , Ossenkoppele Paul M , Haeck Inge M , Hendricksen-Roelofzen Judith H J , Körver John E M , Dodemont Sharon R P , Velstra Berit , Homan Femke M , Berends Maartje A M , Lindhout Robert Jan , Oostveen Annet M , Peters Bas , Mommers Johannes M , van Doorn Martijn B A , Tjioe Milan , Arnold W Peter , Kuijpers Astrid L A , Kleinpenning Marloes M 
Published: August 2024

Abstract

Background
Biologics are effective for the treatment of psoriasis, but little is known regarding patients treated with one biologic for an ‘ultra-long’ duration.

Objectives
To explore the prevalence, patient and treatment characteristics, and treatment outcomes of ultra-long users of biologics for psoriasis.

Methods
Data for patients with psoriasis who had received continuous treatment with the same biologic for ≥ 10 years were collected from the prospective, multicentre BioCAPTURE cohort. Baseline characteristics of these ultra-long users were determined and compared with the total BioCAPTURE population. The proportion of patients using concomitant systemic treatment and receiving dose adjustments, the trajectory of Psoriasis Area and Severity Index scores and drug survival rates beyond 10 years were also analysed.

Results
Among the BioCAPTURE cohort, 30.5% of patients with the potential to achieve a treatment episode of ≥ 10 years reached this treatment duration. These patients were treated with ustekinumab, etanercept, adalimumab and infliximab. The proportion of ultra-long users was highest for ustekinumab (37.1%). The ultra-long user cohort had a slightly longer disease duration at registry entry, and a higher proportion of men and patients diagnosed with psoriatic arthritis (PsA) than the total BioCAPTURE population. Among the cohort, 69.5% of patients had at least one comorbidity and 66.1% used no additional systemic antipsoriatic treatment. Dose adjustments were often applied, varying from dose escalation (29.7%), dose reduction (40.7%) or both (13.6%); only 16.1% of patients consistently used the standard dose throughout their treatment. The median PASI score for ultra-long users from month 6 onwards was consistently &lt; 3, with only a small proportion achieving complete clearance of their psoriasis (3.9–13.7% at the various timepoints). Drug survival analysis beyond 10 years showed that 62.3% of patients were still being treated with the same biologic after 15 years.

Conclusions
Ultra-long use of the same biologic in patients with psoriasis was common in real-world practice but varied between biologics. The median PASI score was around 2.5 throughout the 10-year treatment course; complete clearance was often not achieved. Remarkably, ultra-long use was also recorded in patients with multiple comorbidities (including PsA). Dose adjustments of the biologic were applied in the majority of patients. These results provide clinicians with important evidence on ultra-long treatment with biologics, thereby improving psoriasis care and the management of treatment expectations.