Treatment of Psoriasis with II-17 Inhibitors: Comparison of Long-Term Effectiveness and Drug Survival of Secukinumab vs Ixekizumab in Real-World Practice.

Introduction: The emergence of IL-17A inhibitors, has led to improvements in psoriasis treatment. However, comparative studies addressing their long-term efficacy and drug survival with associated predictors are scarce. The study aimed to compare the characteristics of patients treated with secukinumab or ixekizumab and in addition to analyze associated factors and independent predictors of drug survival in a real-world setting. Methods: This study was designed as a single-center retrospective study. Kaplan-Meier analysis was used to assess drug survival. Log rank test and Cox regression analysis were performed to identify associated factors and possible independent predictors for drug discontinuation. Results: 81 patients have been included in the study. Ixekizumab showed a trend toward faster and higher Psoriasis Area and Severity Index (PASI) 75 and 90 response rates compared to secukinumab at weeks 52 (74.6% versus 55.4%) and 104 (41.5% versus 31.1%). Overall, drug survival rates for ixekizumab were always higher than secukinumab, although the differences were not statistically significant (P = 0.26). Four predictors were identified. For secukinumab, nail psoriasis (hazard ratio [HR]: 0.27, 95% confidence interval [CI]: 0.09-0.83; P = 0.02) was assessed to be a protective factor favoring drug continuation, while five or more previous therapies (HR: 5.52, 95% CI: 1.98-15.40, P = 0.007) were considered a risk factor for discontinuation. In the ixekizumab group, psoriasis inversa was identified as a protective factor (HR: 0.15, 95% CI: 0.03-0.72; P = 0.02), and female sex (HR: 3.47, 95% CI: 1.09-10.99, P = 0.03) was considered a risk factor. Conclusion: Ixekizumab exhibited a non-significant trend toward better long-term efficacy and drug survival compared to secukinumab with slightly lower tolerability. Patient characteristics, including nail psoriasis and treatment history, influenced drug survival differently for each treatment. These findings underscore the importance of personalized treatment strategies in managing psoriasis.