Drug survival of biologics in the treatment of psoriasis

Abstract

Psoriasis is a chronic inflammatory skin disease with a global prevalence of 2-3%. It causes significant disability through its cutaneous manifestations and psychosocial impacts. The past decade has seen significant progress in the management of moderate-to-severe psoriasis through the development of biologic treatments. Drug survival, which refers to the time from treatment initiation to discontinuation, is commonly used as a proxy to measure the safety and efficacy of treatment in a real-world setting. This thesis investigates the drug survival of the currently available biologics in Australia, and the factors contributing to drug discontinuation. This thesis also aims to provide further guidance on the management of psoriasis. Another avenue that warrants further investigation is guidance on biologic-switching if initial treatment fails. Therefore, this thesis also examines the patterns of care across two tertiary dermatology centres in Sydney, Australia, to elucidate ideal treatment sequencing.

Chapter one of this thesis reviews psoriasis and the current evidence pertaining to drug survival of biologics in psoriasis. Chapter two investigates the drug survival of biologics currently approved for the treatment of psoriasis in Australia, and the factors leading to treatment discontinuation. This study provides information on the safety and efficacy of novel biologics in a real-world setting and demonstrates the utility of the newer biologics. Chapter three explores the patterns of care across two tertiary Australian dermatology centres to provide insight into ideal treatment sequencing of biologics. The factors related to biologic-switching are also examined. The study of local patterns of care demonstrated a high uptake of the newer biologics as they became available, which is likely related to their rapid onset of action and clinical efficacy.