PerfIL-17 Study: IL-17 Inhibitor Patterns, Persistence Among Patients with PsA

Findings from the PerfIL-17 study are providing clinicians with an overview of the profile, treatment patterns, and persistence of patients with psoriatic arthritis (PsA) taking secukinumab 150 mg, secukinumab 300 mg, or ixekizumab.

A multicenter, retrospective study conducted at 8 hospital rheumatology departments in Spain, PerfIL-17 is the first real-world evidence study to assess ixekizumab and secukinumab for the treatment of PsA with independent results for 150 mg and 300 mg dosages.¹

“Real-world evidence studies are playing an increasingly significant role in healthcare decision-making, as they provide relevant complementary information to clinical trials in larger and more diverse populations and under clinical practice conditions,” wrote investigators.¹ “However, there are scarce real-world evidence publications related to anti-IL17 for the management of PsA.”

There is currently no cure for PsA, but treatment options focus on controlling inflammation in affected areas to prevent joint pain and disability while controlling skin involvement.² Frequently used to treat psoriatic disease, biologics block proteins in the immune system, such as tumor necrosis factor-alpha, interleukin 17-A, or interleukins 12 and 23, all of which play a major role in developing psoriasis and PsA.³ Understanding treatment patterns and persistence among patients with PsA in a real-life setting may aid clinicians’ decision-making in clinical practice.

Led by Beatriz Joven, MD, of the rheumatology department at University Hospital October 12 in Spain, the PerfIL-17 study sought to examine treatment patterns, drug persistence, and reasons for treatment discontinuation among adult patients with PsA receiving ixekizumab or secukinumab as their first interleukin-17 inhibitor (anti-IL17). Electronic health record data were collected for adults with a confirmed diagnosis of PsA who initiated treatment with secukinumab 150 mg, secukinumab 300 mg, or ixekizumab for the first time between January 2019 and March 2021 and had at least 1 follow-up assessment available.¹

Investigators identified 221 patients with PsA for inclusion in the study, 103 (46.6%) of whom received secukinumab 150 mg, 38 (17.2%) of whom received secukinumab 300 mg, and 80 (36.2%) of whom received ixekizumab. Among the cohort, the mean age when starting an anti-IL17 was 51.5 (Standard deviation [SD], 11.6) years, and 51.6% of patients were male. The mean age at diagnosis of PsA was 43.4 (SD, 12.4) years and the mean duration of PsA disease at the index date was 8.1 (SD, 7.7) years.¹

Upon analysis, secukinumab 150 mg was initiated more frequently in patients with moderate PsA (57.3%) and less peripheral joint involvement (89.3%) than patients on secukinumab 300 mg (92.1%) and ixekizumab (98.8%). Patients on secukinumab 300 mg had greater rates of enthesitis (39.5%) and active skin psoriasis (84.8%). Patients on ixekizumab had the greatest disease duration at 10.5 (SD, 8.2) years and more frequent comorbidities, joint involvement (98.8%), and diagnosed skin psoriasis (95%).¹

Conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) were previously administered in 88.2% of the cohort, including 91.3% of patients taking ixekizumab, 87.4% taking secukinumab 150 mg, and 84.2% taking secukinumab 300 mg. Biologic or targeted synthetic DMARDs were administered in 72.9% of participants, most frequently observed in patients on ixekizumab (93.8%), followed by secukinumab 300 mg (68.4%) and secukinumab 150 mg (58.3%).¹

Investigators noted treatment persistence was greatest at 3 months for the entire cohort (97.2%), with persistence remaining above 90% for each treatment. Persistence decreased to 88.4% at 6 months, with investigators pointing out a substantial decline from 91.9% at 3 months to 66.7% among patients taking secukinumab 300 mg. Overall persistence dropped to 81.0% at 12 months. Patients in the ixekizumab cohort presented the greatest persistence rate at 12 months (86.4%), followed by secukinumab 150 mg (83.1%), and secukinumab 300 mg patients (64.5%).¹

Further analysis revealed secukinumab 300 mg had a 39.5% discontinuation rate, the greatest in the cohort. Secukinumab 150 mg had a discontinuation rate of 28.2% and ixekizumab had the least discontinuation (17.5%). Investigators noted the most frequent reason for discontinuation across all 3 cohorts was lack of effectiveness (16.7%).¹

“The results reported here reflect the high persistence on anti-IL17A in a real-life setting,” concluded investigators.¹ “The PerfIL-17 study yields additional real-world data on the patient’s profile, as well as treatment patterns and reasons for discontinuation of both drugs."

References:

1. Joven B, Manteca CF, Rubio E, et al. Real-World Persistence and Treatment Patterns in Patients with Psoriatic Arthritis Treated with Anti-IL17 Therapy in Spain: The PerfIL-17 Study [published online ahead of print, 2023 Oct 7]. Adv Ther. 2023;10.1007/s12325-023-02693-w. doi:10.1007/s12325-023-02693-w
2. Mayo Clinic. Psoriatic Arthritis. Diseases & Conditions. Accessed October 19, 2023. https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081
3. National Psoriasis Foundation. Biologics. December 14, 2022. Accessed October 19, 2023. https://www.psoriasis.org/biologics/