Ustekinumab Superior for Drug Survival to Other Psoriasis Biologics for Bio-Naïve

New findings suggest, among biologic-naïve (bio-naïve) patients living with psoriasis, ustekinumab has superior drug survival versus adalimumab and secukinumab. Among the bio-experienced, guselkumab, bimekizumab, and risankizumab had superior drug survival.1

These data related to biologic drug survival resulted from a study recently published in JAMA. Christopher Willy Schwarz, MD, PhD, of Copenhagen University Hospital–Herlev and Gentofte’s Department of Dermatology and Allergy, led a team of other investigators in authoring this analysis. Schwarz et al highlighted the notable efficacy of biologic drugs in treating this dermatologic disease, though they noted the need for long-term survival data.2

“The objective of this study was to investigate overall drug survival as well as the absolute risks of treatment discontinuation due to ineffectiveness or adverse events of biologics used to treat psoriasis,” the investigative team wrote.1 “These biologics include bimekizumab, which has not previously been assessed in a large psoriasis population.”

Study Design and Background

In this nationwide cohort study, the investigative team obtained the necessary data in June 2025 from DERMBIO. DERMBIO is Denmark’s national clinical registry for patients given biologic drugs for psoriasis as their primary indication. The registry is known to include more than 90% of biologic-treated psoriasis cases across the country. Patients are enrolled in the registry at treatment initiation, followed by an assessment after approximately 3 to 4 months. Subsequently, they are monitored at various intervals.

In their analysis, Schwarz and colleagues included adults treated in hospital-based dermatology clinics who were registered in DERMBIO between May 2007 - June 2025. Those eligible to take part had initiated treatment with adalimumab, brodalumab, bimekizumab, guselkumab, risankizumab, ixekizumab, secukinumab, or ustekinumab. Courses of treatment were merged when the same biologic was begun again following a short interruption, defined as less than 1 month for adalimumab and brodalumab, under 2 for secukinumab, bimekizumab, ixekizumab, and guselkumab, and under 4 for ustekinumab as well as risankizumab.

Those involved as participants were allowed to contribute to more than 1 treatment arm, though they were only counted once per therapy, using their first recorded treatment series. Characteristics at the point of baseline were updated at the initiation of each new drug, with originator products and biosimilars being treated by the investigators as equivalent.

Analyzation of subjects occurred separately, with Schwarz and coauthors basing this on previous exposure to biologics, distinguishing those who were biologic-naïve. In their study’s main endpoint, the investigative team looked at the standardized absolute risk of drug cessation at the 1, 2, and 5-year marks. Crude drug survival was estimated via the use of Kaplan–Meier methods, while cause-specific absolute risks were determined through the Aalen–Johansen estimator.

Comparisons of Biologic Drug Survival Rates

The cohort was made up of 4438 individuals with diagnosed psoriasis, of whom 61.2% were reported to be male.1 At the first included treatment, the mean age was shown to be 45.0 years. 23.4% of those evaluated had concomitant psoriatic arthritis (PsA). Among those who were biologic-naïve, 3790 treatment series were examined. There were:

• 377 with secukinumab
• 2646 with adalimumab
• 767 with ustekinumab.

The standardized risk of drug discontinuation at Year 5 was .37 (95% CI, .33–.41) for ustekinumab.1 This, Schwarz et al highlighted, was a significantly lower risk than the risk observed with adalimumab at .51 (95% CI, .49–.54) and with secukinumab at .54 (95% CI, .48–.60).

Among those deemed bioexperienced, there were 3403 treatment series included:

• 376 with bimekizumab
• 790 with adalimumab
• 192 with brodalumab
• 556 with ixekizumab
• 78 with risankizumab
• 218 with guselkumab,
• 466 with secukinumab
• 727 with ustekinumab

The investigative team noted the standardized absolute risk of cessation for ustekinumab at Year 2 had been .39 (95% CI, .36–.43).1 Discontinuation rates compared with ustekinumab were significantly lower only for bimekizumab at .27 (95% CI, .20–.34), risankizumab at .25 (95% CI, .15–.36), and guselkumab at .29 (95% CI, .22–.36).

Schwarz and colleagues summarized their findings, noting the drug survival rates of these treatments among both types of patients with psoriasis.

“Among bioexperienced patients with psoriasis, bimekizumab, guselkumab, and risankizumab had the highest 2-year drug survival,” they concluded.1 “These findings highlight differences in treatment persistence across biologics and may inform treatment selection in routine clinical practice.”

References

1. Schwarz CW, Loft N, Bryld LE, et al. Drug Survival of Biologics in Bionaive and Bioexperienced Patients With Psoriasis. JAMA Dermatol. Published online January 07, 2026. doi:10.1001/jamadermatol.2025.5205.

2. Sbidian E, Chaimani A, Guelimi R, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev. 2023;7(7):CD011535. doi:10.1002/14651858.CD011535.pub6.