A review of real-world efficacy data for adalimumab shows it has sustained effectiveness for Australian psoriasis patients despite users having higher disease severity than what was tested in clinical trials.

The analysis, published in Australasian Journal of Dermatology, gives clinicians a picture of median drug survival. It also demonstrates certain factors, like male sex and achieving a PASI score of ≤2, predicts longer drug survival in Australian patients.

Dermatologists included data from 306 patients, with close to 60% having prior biologic exposure compared with just 12.8% in the REVEAL phase 3 clinical trial for adalimumab. The key takeaways were:

• 63.5% of patients achieved PASI75 and 33.6% achieved a PASI90 score at 3 months,
• Median drug survival was 27.9 months for Australian patients, with close to 98% of patients achieving survival of three months or more,
• Male sex and older age were associated with longer drug survival, while liver disease was associated with an increased risk of discontinuation.

Patients in the local cohort had a mean baseline PASI score of 24.1, significantly higher than the 18.3 in the REVEAL trial. This, combined with the number of patients already treated with at least one biologic, suggested a “more treatment experienced and potentially refractory” population, the authors said.

“This may also in part reflect Australian prescribing criteria which require patients to have severe disease inadequately controlled with conventional therapies to access biologics unlike the clinical trials which included patients with moderate to severe psoriasis, irrespective of prior therapies,” they noted.

These differences didn’t appear to impact treatment response rates, which were comparable with the phase 3 trial results.

Drug survival was 63.7% at 15 months and 51% at 27 months, which was slightly lower than rates reported in UK registry data.

The differences in drug retention could come down to difference patient populations or the increasing availability of alternative biologics in Australia, the authors suggested.

Associate Professor Peter Foley at Skin Health Institute co-authored the analysis.

“Despite the growing number of biologic options, adalimumab remains PBS listed for multiple indications including hidradenitis suppurativa, psoriatic arthritis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis and non-infectious uveitis,” they said.

“This makes it a versatile treatment that should be considered in patients with coexisting inflammatory conditions.”

Male sex was associated with longer drug survival, but there was no association found for a range of other factors, including BMI, smoking history or prior biologics exposure.

These findings reinforced the value of adalimumab for a broad range of Australian patients with psoriasis, the authors argued.

“These findings reinforce adalimumab’s broad applicability across diverse patient populations in everyday clinical practice.”