Title: Reply to: “Comment on ‘Drug survival of secukinumab and ixekizumab for moderate-to-severe plaque psoriasis'”
Abstract: To the Editor: Dr Lebwohl correctly comments that the 12-month drug survival for secukinumab and ixekizumab in our recent manuscript1Egeberg A. Bryld L.E. Skov L. Drug survival of secukinumab and ixekizumab for moderate-to-severe plaque psoriasis.J Am Acad Dermatol. 2019; 81: 173-178Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar was higher than previous real-world studies. He further notes that previous biologic exposure, body weight, and body mass index (BMI) may lead to lower persistence in clinical practice. We emphasize that estimation of statistical significance in persistence rates between secukinumab and ixekizumab should be done with great caution from non-randomized data. Indeed, it is important to note that 40.7% of patients treated with secukinumab in our study were bio-naïve, whereas only 12.9% of patients receiving ixekizumab were bio-naïve. As evident from Fig 3 in our original paper,1Egeberg A. Bryld L.E. Skov L. Drug survival of secukinumab and ixekizumab for moderate-to-severe plaque psoriasis.J Am Acad Dermatol. 2019; 81: 173-178Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar the survival of secukinumab was predominantly driven by bio-naïve patients. Notably, patients that had been treated with just 1 biologic prior to starting secukinumab only had a 50% survival probability at 30 months, suggesting a markedly lower performance compared to clinical trial data. Moreover, both body weight and BMI were in fact lower for patients treated with secukinumab than those receiving ixekizumab therapy (Table 1 in the original manuscript), which would arguably bias in favor of a higher performance of secukinumab than ixekizumab (which was not the case). It is important to note that conclusive evidence should not be inferred from 1 study alone, however, the current sum of evidence from independently conducted studies2van den Reek J. van Vugt L.J. van Doorn M.B.A. et al.Initial results of secukinumab drug survival in patients with psoriasis: a multicentre daily practice cohort study.Acta Derm Venereol. 2018; 98: 648-654Crossref PubMed Scopus (49) Google Scholar, 3Georgakopoulos J.R. Ighani A. Phung M. Yeung J. Drug survival of secukinumab in real-world plaque psoriasis patients: a 52-week, multicenter, retrospective study.J Am Acad Dermatol. 2018; 78: 1019-1020Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 4Egeberg A. Ottosen M.B. Gniadecki R. et al.Safety, efficacy and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis.Br J Dermatol. 2018; 178: 509-519Crossref PubMed Scopus (201) Google Scholar, 5Lunder T. Zorko M.S. Kolar N.K. et al.Drug survival of biological therapy is showing class effect: updated results from Slovenian National Registry of psoriasis.Int J Dermatol. 2019; 58: 631-641Crossref PubMed Scopus (21) Google Scholar, 6Torres T. Balato A. Conrad C. et al.Secukinumab drug survival in patients with psoriasis: a multicenter, real-world, retrospective study.J Am Acad Dermatol. 2019; 81: 273-275Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar suggest that secukinumab does possess a conspicuously lower performance in real life compared with clinical trials. As eloquently demonstrated by data from the UK registry BADBIR, results obtained from clinical trials are not representative of patients seen in real-world settings.7Mason K.J. Barker J. Smith C.H. et al.Comparison of drug discontinuation, effectiveness, and safety between clinical trial eligible and ineligible patients in BADBIR.JAMA Dermatol. 2018; 154: 581-588Crossref PubMed Scopus (60) Google Scholar Interleukin-17 inhibitors such as secukinumab and ixekizumab are frequently used for treatment of psoriasis, and although between-drug comparisons should be cautioned in non-randomized cohorts, real-world drug utilization data may add nuance to the current discussion of how to best manage patients with moderate-to-severe plaque psoriasis. Comment on “Drug survival of secukinumab and ixekizumab for moderate-to-severe plaque psoriasis”Journal of the American Academy of DermatologyVol. 85Issue 6PreviewTo the Editor: We read with interest the article by Egeberg et al reporting the drug survival of secukinumab and ixekizumab for patients with moderate to severe plaque psoriasis from DERMBIO, a national Danish registry for psoriasis patients receiving biologics.1 The overall 12-month drug survival rates of approximately 84% (58/368 discontinued) for secukinumab and 87% (8/62 discontinued) for ixekizumab in this study are high, with no significant difference, and are comparable to those previously reported from clinical trials. Full-Text PDF