Comparative drug survival of biologic classes in psoriasis: a Japanese single-centre cohort study

Drug survival reflects the long-term effectiveness, safety, and tolerability of biologic therapies in routine clinical practice. To compare drug survival among currently available biologic classes in Japanese patients with psoriasis and to evaluate reason-specific discontinuation. We conducted a retrospective cohort study including 538 biologic treatment episodes from 311 patients treated at a tertiary dermatology centre in Japan. Tumour necrosis factor, interleukin-17, interleukin-23, and interleukin-12/23 inhibitors were compared. Overall drug discontinuation was assessed using multivariable Cox proportional hazards models with cluster-robust standard errors. Discontinuation due to ineffectiveness and adverse events was evaluated using Fine-Gray competing risk models. Compared with tumour necrosis factor inhibitors, interleukin-23 inhibitors were associated with more favourable overall drug survival (adjusted hazard ratio: 0.43, 95% confidence interval: 0.25-0.74; p=0.002), which remained significant in the 104-week analysis (hazard ratio: 0.50, 95% confidence interval: 0.28-0.91; p=0.023). Interleukin-17 inhibitors and ustekinumab did not differ significantly from tumour necrosis factor inhibitors in the primary analysis. In competing risk analyses, interleukin-23 inhibitors showed a lower risk of adverse event-related discontinuation than tumour necrosis factor inhibitors (subdistribution hazard ratio: 0.10, 95% confidence interval: 0.02-0.59; p=0.010), whereas no significant class differences were observed for ineffectiveness-related discontinuation. Interleukin-23 inhibitors showed the most favourable drug survival profile, primarily driven by reduced adverse event-related discontinuation.