Comparison of drug survival rates for adalimumab, etanercept and infliximab in patients with psoriasis vulgaris

Source: Br J Dermatol

Gniadecki R, Kragballe K, Dam TN, Skov L;

British Journal of Dermatology (Jan 2011)


·         adalimumab

·         etanercept

·         infliximab

·         Psoriasis

Background  Adherence to treatment is an indicator of treatment success. Long-term data on adherence to biologic treatment in psoriasis are lacking. Objectives  To compare the TNF-α inhibitors regarding drug survival rate and safety in patients with psoriasis. Methods  This study is based on data from the Danish nationwide database DERMBIO covering patients with psoriasis treated with a biologic agent. All patients, who received anti-TNFα treatment in academic referral centers, were included. Baseline data, adverse events, time on treatment and reason for stopping treatment were recorded. Hazard ratios (HRs) for factors determining drug survival were calculated by logistic regression. Results  In total 882 treatment series with etanercept (n=311), adalimumab (n=427) or infliximab (n=144) were administrated to 747 patients. Significant predictors of drug survival were: sex, the anti-TNFα agent and the previous response to the anti-TNFα. In the group of the anti-TNFα naïve patients the longest drug survival was observed for infliximab, followed by adalimumab (hazard ratio vs infliximab 3.70, 95% CI=1.99-6.89) and etanercept (hazard ratio vs infliximab 3.18, 95% CI=1.72-5.86). The 4-year drug survival is in the range of 40% for etanercept or adalimumab vs 70% for infliximab. There was no difference in number of adverse events. Conclusion  The overall efficacy of anti-TNFα drugs diminishes with time, as envisaged by the progressive loss of patient adherence to treatment. The major reasons for stopping treatment were loss of efficacy, followed by adverse events. Infliximab had the best patient retention ability with 70% patients being still on drug after 4 years of treatment.


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