Biologic drug survival in psoriasis: insights from a multi-center retrospective study in West Malaysia

Psoriasis is a chronic immune-mediated skin disorder with significant impact on patients' quality of life. Biologic therapies have revolutionized the treatment of moderate-to-severe psoriasis, but data on their long-term effectiveness, measured through drug survival rates, remains limited in Malaysia. This study aimed to analyze the drug survival of biologic therapies and identify factors influencing treatment discontinuation among psoriasis patients in Malaysia.

This retrospective cohort study analyzed 285 psoriasis patients receiving 437 biologic treatment courses in 10 tertiary hospitals in West Malaysia. Data on demographic characteristics, clinical profiles, and biologic treatments were collected and analyzed. Drug survival was evaluated using Kaplan-Meier analysis, and predictors of treatment discontinuation were identified using Cox proportional hazards modeling.

The study cohort had a mean psoriasis onset age of 28 (⊕ 13) years, with biologic initiation at 39 (⊕ 16) years. Secukinumab (53.7%) was the most commonly prescribed first-line biologic, followed by Ustekinumab (28.1%). Loss of efficacy was the leading cause of discontinuation, increasing from 49.6% in the first line to 100% by the fifth. Kaplan-Meier analysis showed Secukinumab had the longest mean survival (45.5 months), followed by Ustekinumab (41.4 months) and Rizankizumab (41.3 months). Cox regression revealed prior biologic use significantly increased discontinuation risk (HR = 1.415, p = 0.049), while diabetes mellitus approached significance increase discontinuation risk (HR = 1.575, p = 0.054).

Biologic drug survival in Malaysian psoriasis patients reflects global trends, with Secukinumab demonstrating superior durability. Loss of efficacy and funding issues were key barriers to persistence. The findings emphasize the need for optimized treatment strategies with wider access to biological treatment.