Durability of Biologics for Psoriasis Compared, Adjusted for Drug Switching Over Time

Ixekizumab (IXE) delivers more durable high-level skin clearance among patients with psoriasis than several other commonly used biologic drugs, new-real world data suggest.1

These data were authored by such investigators as Andreas Pinter, MD, PhD, from the Department of Dermatology at the University Hospital Frankfurt am Main in Germany. The findings were presented in a poster session at the 2025 Fall Clinical Dermatology Conference in Las Vegas, Nevada.

Despite the variety of biologic agents targeting the various inflammatory pathways in psoriasis, Pinter and coauthors pointed to the prior lack of long-term, real-world comparative data. They noted this to be particularly true data on the durability of high-level skin clearance in such patients.

To address the limited level of research on this, the investigative team carried out Psoriasis Study of Health Outcomes (PSoHO) study as a 36-month, non-interventional, international cohort study. They looked into the long-term efficacy of commonly used biologic agents in routine clinical practice settings, involving 1981 adult subjects residing in 23 countries. The team also looked at a European Medicines Agency (EMA) on-label sub-population in their research.

In this particular analysis, Pinter et al focused on the most recent pre-specified endpoints: the durability of Psoriasis Area and Severity Index (PASI)100 and PASI90 responses among subjects. The investigators defined durability as attainment, at the 12-week mark, of PASI100 or PASI90 and maintaining that response at the 6, 12, 18, and 24-month marks.

Confounding variables such as drug cessation, treatment switching, and baseline differences were taken into account by Pinter and coauthors via their use of marginal structural models (MSM). These models generated adjusted odds ratios (ORs) with 95% confidence intervals for IXE compared with tildrakizumab (TILD), secukinumab (SEC), risankizumab (RIS), adalimumab (ADA), guselkumab (GUS), and ustekinumab (UST).

Outcomes were reported both with non-responder imputation (NRI) and as observed. In Pinter and colleagues' adjusted analysis of the overall population, they found IXE demonstrated increased odds of attaining and sustaining PASI90 and PASI100 responses as opposed to SEC, TILD, GUS, ADA, and UST. When compared with RIS, IXE was shown by Pinter and coauthors to have similar odds of durability for both PASI90 and PASI100.

They pointed to comparable long-term performance between these interleukin (IL)-17 and IL-23 pathway inhibitors. The study's European Medicines Agency (EMA) on-label subgroup yielded largely consistent findings with those of the overall population. However, a single distinction did come about for PASI100 durability. Specifically, the investigators found in this subgroup, patients being given IXE were found to have significantly greater odds of maintaining complete skin clearance as opposed to patients treated with RIS.

Additionally, results were shown to be comparable to those of patients receiving SEC. The PSoHO data emphasized the clinical relevance of durability as a central therapeutic aim in the management of psoriasis. Prior data, Pinter et al noted, has demonstrated that individuals who attain a PASI100 score earlier accumulate more days with minimal impact on quality of life, as measured by DLQI scores of 0 or 1. Consequently, they added, durability not only suggests biologic efficacy but also translates into meaningful patient-centered outcomes.

Aligning with many long-term observational cohorts, the PSoHO study faced potential bias related to switching between treatments. Drug switching may be impacted by disease severity, treatment access, comorbid psoriatic arthritis, costs of medication, or response levels. The implementation of MSM was intended to address such sources of confounders and strengthen the validity of comparative findings.

For any further information on topics such as these, view the latest coverage of the Fall Clinical Dermatology Conference.

References

1. Pinter A, Brnabic A, Maul JT, et al. Comparative Durability of Biologics for Patients With Moderate-to-Severe Psoriasis Adjusted for Drug Switching Over Time: 24-Month Outcomes From the International Observational Psoriasis Study of Health Outcomes (PSoHO). Poster presented at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

2. Yu N, Wang Y, Cui L, et al. Comprehensive analysis of effectiveness and cost‐effectiveness of treatments for psoriasis integrating clinician‐ and patient‐reported outcomes: A cohort study from speech. Dermatologic Therapy. 2025;2025(1). doi:10.1155/dth/9464860.