Biological Therapy for Moderate-to-Severe Psoriasis: A 5-Year Analysis of Patients from Lithuania

Background and Objectives: Biological therapy is widely used to treat moderate-to-severe psoriasis. This study aimed to assess the real-world effectiveness and drug survival of biologic treatment in patients with moderate-to-severe psoriasis. Materials and Methods: A retrospective study of 210 patients with moderate-to-severe psoriasis who were treated with biological therapy between 2018 and 2023 was conducted. Baseline data included demographics, comorbidities, prior treatments, Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores, laboratory results, current psoriasis treatment, and treatment-related adverse events. Results: Of the 210 patients, 60.0% were male (n = 126). The mean age was 48.3 ± 13.6 years in men (range 16-74) and 48.4 ± 13.6 years in women (range 17-79). The mean PASI at initiation of biologic therapy was 15.0 ± 8.1 and decreased to 3.3 ± 4.7 at 1 year, 2.7 ± 4.0 at 3 years, and 2.8 ± 3.3 at 5 years. Drug discontinuation differed between therapies: etanercept had a higher hazard of discontinuation than ustekinumab (hazard ratio (HR) 2.55, 95% confidence interval (CI) 1.17-5.52; p = 0.0179), infliximab (HR 0.36, 95% CI 0.13-0.97; p = 0.0429) and adalimumab (HR 0.47, 95% CI 0.23-0.98; p = 0.0453). Conclusions: In routine clinical practice, biologic therapy was associated with substantial and sustained improvements in the PASI over up to 5 years of follow-up. Drug survival was initially high for all agents but separated over time, with etanercept showing the poorest long-term persistence and a higher hazard of discontinuation compared with other drugs.