OBJECTIVES: Biologic agents for moderate-to-severe psoriasis (PsO) target cytokines involved in the pathogenesis namely tumor necrosis factor alpha (TNFα) and interleukins (IL) -12, 17 and 23. However, persistence (i.e. time between initiation and discontinuation) of biologics is affected by several factors. For example, second line persistence rates are impacted by the selected biologic in the first line. Therefore, we aimed to evaluate the drug persistence rates of biologics in the second treatment line according to prior biologic exposure.

METHODS: Psoriatic patients that had initiated a second-line biologic treatment between January 1st 2016 and December 31st 2020 based on national prescription database, were included in the present study. Persistence rates were estimated with the Kaplan-Meier method.

RESULTS: Collectively, 1,857 patients initiated a second line biologic treatment. Among them, 17.8% were diagnosed with concomitant psoriatic arthritis. Most patients (37.7%) were treated with anti-IL17A followed by those treated with anti-IL-12/23 (28.1%). The overall median drug survival at the second line was 30.8 [95% confidence interval: 27.2 – 39.0] months and the 12- and 24-month persistence rates were 70.0% and 55.4%, respectively. At 12- and 24-months patients treated with anti-interleukins had higher rates (71.7% and 59.5%, respectively) compared to those treated with anti-TNFα (61.5 and 41.9%, respectively). The persistence rates for anti-interleukins were statistically significantly higher at second line compared to the rates observed for anti-TNFα, even after controlling for the biologic received at first line. Of note, patients treated with anti-TNFα biologics initially, had increased persistence rates when switched to anti-interleukins biologics in the second line compared to an interclass switching.

CONCLUSIONS: We observed that drug persistence rates of anti-interleukins biologics are higher compared to anti-TNFα as a second line of treatment. However, first line treatment does not seem to affect them. These results will contribute to the improvement of psoriasis management in Greece.