Comparison of the 1‐ and 5‐year effectiveness of adalimumab, etanercept and ustekinumab in patients with psoriasis in daily clinical practice: results from the prospective BioCAPTURE registry

Background The efficacy of etanercept and ustekinumab in psoriasis has been compared in one randomized controlled trial. Comparison of the long-term effectiveness of biologics in daily practice psoriasis treatment is currently lacking. Objectives To compare the effectiveness between the three widely used outpatient biologics adalimumab, etanercept and ustekinumab in daily practice psoriasis treatment and to correct for confounders. Methods Data were extracted from the prospective, multicenter BioCAPTURE registry. Multilevel linear regression analyses (MLRA) and generalized estimating equation (GEE) analyses were performed on, respectively, course of mean PASI and PASI75 (75% reduction of PASI compared to baseline). Both models were corrected for confounders. Subgroup analyses for biologic dose were performed. Results We included 356 patients with 513 treatment episodes; 178 adalimumab, 245 etanercept, 90 ustekinumab. MLRA showed a similar effectiveness between adalimumab, etanercept and ustekinumab after one year, but the highest effectiveness for ustekinumab during five years of treatment (p=0.047; ustekinumab versus etanercept p=0.019). GEE analysis revealed a higher chance of attaining PASI75 with adalimumab and ustekinumab compared to etanercept at one year of treatment. A higher than label dose was more often used in patients treated with etanercept (adalimumab, etanercept and ustekinumab: 31.5%, 55.1% and 16.7% after one year [p<0.001]; 39.3%, 71.4% and 24.4% after five years [p<0.001]). Conclusions Ustekinumab had, compared with etanercept, the highest effectiveness during five years of treatment. Adalimumab and ustekinumab more often reached PASI75 than etanercept at one year of treatment. Dose escalation was more frequent in etanercept and adalimumab compared with ustekinumab. This article is protected by copyright. All rights reserved.