Drug survival of conventional systemic and biologic therapies for moderate-to-severe psoriasis in clinical practice in Spain: prospective results from the SAHARA study

Background: A better understanding of determinants for drug survival of antipsoriatic agents may guide dermatologists in the right therapeutic choice. Objectives: To describe 2-year drug survival of conventional and biologic antipsoriatic treatments. Methods: SAHARA was a prospective study in patients with moderate-to-severe psoriasis who initiated a conventional or biologic drug. Kaplan-Meier analysis estimated the drug survival and Cox regression the predictors of treatment persistence at two years. Results: A total of 552 patients were included (conventional group n = 181, biologic group n = 371). After a median treatment duration of 21.4 months, more than 50% of patients remained on methotrexate, etanercept, and ustekinumab whereas the median exposition time to cyclosporine, acitretin, and adalimumab was 11.8, 10.6, and 25.5 months, respectively. There were 178 discontinuations for all causes, mainly in patients who initiated cyclosporine (58.3%), acitretin (52.8%), and adalimumab (46%), and less frequently with ustekinumab (14%). The main reason for discontinuing biologics was lack of efficacy (70%), especially for etanercept (76%). Conclusion: Biologics have a superior drug survival rate than conventional therapies. Ustekinumab is the biologic with the longest drug survival, only affected by the gradual loss of efficacy assumed for biological therapies.