A new analysis of Danish registry data highlights differential long-term drug survival of commonly used biologics in patients with psoriasis, providing clinicians with insight to guide appropriate treatment selection for patients.
This nationwide cohort study examined the real-world drug survival of biologic therapies used to treat psoriasis, with a particular focus on differences between those without previous biologic exposure (bionaive) patients and those previously exposed to biologics – known as bioexperienced patients.
The researchers sought to address the limited observational evidence for newer agents, including bimekizumab, in routine clinical practice. They analysed data from the Danish DERMBIO registry, which captures more than 90% of biologic treatments for psoriasis across Denmark.
Adult patients initiating biologic therapy between May 2007 and June 2025 were included. In total, 4,438 unique patients contributed 7,193 treatment series. The cohort had a mean age of 45 years at the time of their first treatment included in the study, 61.2% were male and 23.4% had comorbid psoriatic arthritis.
The primary outcome was standardised absolute risks of treatment discontinuation at one, two and five years.
Superior drug survival for bionaive and bioexperienced patients
Among 3,790 treatment series in biologic-naive patients, adalimumab, secukinumab and ustekinumab were evaluated. Ustekinumab demonstrated the most favourable long-term drug survival, with a five-year standardised absolute risk of all-cause treatment discontinuation of 0.37, compared with 0.51 for adalimumab and 0.54 for secukinumab.
Discontinuation due to both ineffectiveness and adverse events was consistently lower with ustekinumab over five years.
The bioexperienced group comprised 3,403 treatment series across eight biologics. At two years, risankizumab (0.25), bimekizumab (0.27) and guselkumab (0.29) were associated with significantly lower standardised risks of discontinuation compared to ustekinumab at 0.39.
These agents also showed favourable profiles when discontinuation due to ineffectiveness or adverse events was examined separately.
The authors concluded that among bionaive patients with psoriasis, ustekinumab had superior drug survival compared with adalimumab and secukinumab. For bioexperienced patients, bimekizumab, guselkumab and risankizumab had superior drug survival.
Clinically relevant insight for psoriasis treatment selection
They noted several limitations inherent to observational registry studies, including residual confounding, missing data for some clinical variables and shorter follow-up for newer biologics. In addition, treatment patterns were influenced by national prescribing guidelines, which may limit generalisability to other healthcare systems, they said.
Despite these constraints, the findings provide clinically relevant insight into biologic performance in routine care. The authors highlight the value of drug survival as a pragmatic outcome and suggest that these data may support more informed treatment selection for patients with psoriasis, particularly when considering prior biologic exposure.
Last year, research found patients with psoriasis who showed an early response to treatment with the biologics risankizumab or guselkumab were more likely to respond well to treatment over the long term.
Reference
Schwartz C et al. Drug Survival of Biologics in Bionaive and Bioexperienced Patients with Psoriasis. JAMA Dermatol 2026;doi:10.1001/jamadermatol.2025.5205.
This article was originally published by our sister publication Hospital Healthcare Europe.
