Enbrel long term drug-survival analysis

[Fred]

This article published in The British Journal of Dermatology is the longest drug-survival analysis of Enbrel (etanercept) for psoriasis and goes up to 7.5 years.

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Background:
Long-term data of etanercept drug-survival in psoriasis patients in daily-practice are scarce.

Objectives:
Primary objective was to describe drug-survival for etanercept in a long term daily practice cohort of patients with psoriasis. Secondary objective was to identify determinants of drug-survival for etanercept in general and separately for discontinuation due to adverse events or inefficacy of therapy.

Methods:
Data were extracted from a prospective daily-practice cohort of patients treated with biologics for psoriasis. Drug-survival was analyzed by Kaplan-Meier survival-curves and split for two reasons for discontinuation: adverse events and inefficacy. Determinants of drug-survival were analyzed in univariate Cox-regression analysis and in multivariate Cox-regression analysis with backward-selection.

Results:
We included 193 patients (512 treated patient years) with a maximum treatment duration of 7.5 years. The overall drug-survival was 77%, 41% and 30% after 1, 4 and 7.5 years, respectively. The mean survival duration was 3.8 years [95% confidence interval (CI95%) 3.4-4.3]. Reasons for discontinuation were inefficacy (33.7%), adverse events (11.9%), both inefficacy and adverse events (4.7%) or other reasons (e.g. pregnancy wish) (5.7%)). Determinants of longer general drug-survival were male sex (Hazard ratio (HR=0.55), prior anti-TNF-alpha use (HR=0.57), and lower etanercept dose (HR 0.65). Younger age (HR 0.83), lower BMI (HR=0.63) and lower etanercept dose (HR=0.71) decreased the risk of discontinuation due to side-effects. A lower mean weekly dose of etanercept (HR=0.63) decreased the risk of discontinuation due to inefficacy of therapy.

Conclusions:
We present the longest drug-survival analysis of etanercept for psoriasis until now. The overall drug survival was 77%, 41% and 30% after 1, 4 and 7.5 years, respectively and a median drug-survival duration of 3 years. Determinants of longer overall etanercept drug-survival were male sex, prior anti-TNF therapy and lower etanercept dose. The determinants of longer drug-survival depended on the reason for discontinuation of etanercept.

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