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. 2022 Feb 1;158(2):184-188.
doi: 10.1001/jamadermatol.2021.4805.

Drug Survival of Biologics in Patients With Hidradenitis Suppurativa

Hans Christian Ring  1 , Julia-Tatjana Maul  2 , Yiqiu Yao  1 , Jashin J Wu  3 , Jacob P Thyssen  1 , Simon F Thomsen  1   4 , Alexander Egeberg  1
Affiliations

Drug Survival of Biologics in Patients With Hidradenitis Suppurativa

Hans Christian Ring et al. JAMA Dermatol. .

Abstract

Importance: Biologics are important in treating patients with hidradenitis suppurativa (HS). However, to our knowledge, data on their real-life performance and treatment patterns in HS are limited.

Objective: To examine the drug survival of biologic therapies for HS in a real-world setting.

Design, setting, and participants: This cohort study included all patients with HS between January 1, 2005, and December 31, 2018, who were treated with biologics at the 5 academic hospital clinics where all biologic treatment for HS is conducted in Denmark. Biologics included adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, secukinumab, and ustekinumab. Data were analyzed between June 1, 2021, and June 20, 2021.

Main outcomes and measures: Drug survival was depicted through Kaplan-Meier curves, and Cox regression models were used to calculate adjusted (age, sex, previous number of biologic treatment series) hazard ratios (aHRs) with 95% CIs for the risk of treatment discontinuation. Switching patterns were visualized through a Sankey diagram.

Results: The study comprised 241 patients (176 women [61.8%]; total of 386 treatment series) with a mean (SD) age of 41.8 (12.6) years at initiation of first biologic therapy. There were a total of 256 (189 [73.8%] biologic naive), 66 (32 [48.5%] biologic naive), 23 (9 [39.1%] biologic naive), and 22 (9 [40.9%] biologic naive) treatment series with adalimumab, infliximab, etanercept, and ustekinumab, respectively. The median time to discontinuation was 36.0 (IQR, 21.9-63.0), 28.7 (IQR, 15.1-62.9), 26.0 (IQR, 16.9-155.9), and 17.9 weeks (IQR, 12.9-41.0) for adalimumab, infliximab, ustekinumab and etanercept, respectively. The risk of drug discontinuation was significantly higher for etanercept compared with adalimumab (aHR, 1.81; 95% CI, 1.16-2.82), infliximab (aHR, 1.77; 95% CI, 1.03-3.05), and ustekinumab (aHR, 2.49; 95% CI, 1.12-5.52), whereas no difference was observed when comparing these 3 therapies with each other. We found no significant differences in drug survival for biologic-naive vs nonnaive treatment series. Increasing C-reactive protein levels (aHR, 1.01; 95% CI, 1.00-1.03) and concomitant antibiotic treatment (aHR, 2.82; 95% CI, 1.36-5.86) were associated with the risk of discontinuing infliximab therapy. Men (aHR, 0.69; 95% CI, 0.51-0.91) had a reduced risk of discontinuing use of adalimumab.

Conclusions and relevance: In this cohort study, drug survival was comparable between adalimumab, infliximab, and ustekinumab but significantly lower for etanercept. There were no differences in drug survival among biologic-naive and nonnaive patients.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Maul reported serving as an advisor for and receiving speaking fees from AbbVie, Almirall, Amgen, BMS, Celgene, Eli Lilly, LEO Pharma, Janssen-Cilag, MSD, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi, and UCB. Dr Thyssen reported personal fees from Regeneron, LEO Pharma, Lilly, AbbVie, Almirall, Sanofi-Genzyme, and Pfizer outside the submitted work. Dr Thomsen reported grants from AbbVie, Novartis, Sanofi, UCB, Janssen, and LEO Pharma and advisory board service for AbbVie, Almirall, Novartis, Eli Lilly, Sanofi, Janssen, LEO Pharma, Pfizer, and UCB outside the submitted work. Dr Egeberg reported research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation and honoraria from AbbVie, Almirall, LEO Pharma, Zuellig Pharma Ltd, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co, Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol Myers Squibb, and Janssen Pharmaceuticals. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Overall Drug Survival Through 156 Weeks
Figure 2.
Figure 2.. Visualization of Switching Patterns in Patients With Hidradenitis Suppurativa Who Were Treated With Biologics
See this image and copyright information in PMC

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