Among patients with psoriasis who had not previously received biologic therapy (bionaive), ustekinumab demonstrated higher drug survival than adalimumab or secukinumab, according to a recent cohort study. Among patients with previous biologic exposure (bioexperienced), bimekizumab, guselkumab, and risankizumab had the highest 2-year drug survival. The findings highlight differences in treatment persistence across biologics and may help guide therapy selection in routine clinical practice.

Researchers analyzed data from the DERMBIO registry, which includes all patients treated with biologics for psoriasis in Denmark, with an estimated national coverage greater than 90%. All adult patients enrolled in DERMBIO from its commencement in May 2007 through June 2025 were evaluated for eligibility. Data were extracted in June 2025 and analyzed separately among bionaive and bioexperienced patients.

The study cohort comprised 4,438 patients with psoriasis (61% male; mean age, 45 years at the time of their first treatment included in the study), 23% of whom had comorbid psoriatic arthritis. A total of 3,790 treatment series from bionaive patients were analyzed: adalimumab (n = 2,646), secukinumab (n = 377), and ustekinumab (n = 767).

At 5 years, the standardized risk of treatment discontinuation was lowest with ustekinumab at 37%, compared with 51% for adalimumab and 54% for secukinumab.

In the bioexperienced cohort, 3,403 treatment series were evaluated across eight biologics: adalimumab, bimekizumab, brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, and ustekinumab. At 2 years, the standardized absolute risk of discontinuing ustekinumab was 39%. Only bimekizumab (27%), guselkumab (29%), and risankizumab (25%) were associated with a statistically significantly lower standardized absolute risk of discontinuation compared with ustekinumab.

Unadjusted 1-year drug survival in bioexperienced patients was highest for bimekizumab at 83% and risankizumab at 82%. For several agents, including adalimumab, secukinumab, and ustekinumab, 1-year survival was lower among bioexperienced patients than among bionaive patients.

"These findings highlight differences in treatment persistence across biologics and may inform treatment selection in routine clinical practice," wrote lead study author Christopher Willy Schwarz, MD, PhD, of Copenhagen University Hospital–Herlev and Gentofte in Denmark, and colleagues.

Disclosures can be found in the study.

Source: JAMA Dermatology