(027) Prescribing Patterns of Biological Therapies in Psoriasis Management: A Retrospective Cohort Study in Saudi Arabia

Background: Psoriasis is a chronic, autoimmune, hereditary disease characterized by well-defined scaly plaques and mild irritation. Biological therapies have shown effectiveness in treating psoriasis; however, some patients do not respond well and may switch therapies during their treatment courses.

Objectives: This study aimed to elucidate physicians' prescribing patterns of biological therapies at a referral tertiary center in the eastern region of Saudi Arabia. Additionally, we sought to assess the probability of biological therapy persistence following initiation.

Methods: We conducted a retrospective observational study at specialized dermatology outpatient clinics in Dammam, Saudi Arabia. Eligible participants included adult psoriasis patients (≥ 18 years old) who were biologic-naïve and initiated biologic therapies between October 2013 and July 2022. Descriptive statistics and visualization techniques were utilized. The Kaplan-Meier model evaluated treatment persistence at 6, 12, 24, and 36 months.

Results: The total number of patients who initiated biological therapies was 151 (n=17 on etanercept, n=89 on adalimumab, n=14 on ustekinumab, n=30 on risankizumab, and n=1 on ixekizumab). Most patients did not receive concomitant systemic therapy (77.4%). Etanercept and adalimumab were the predominant prescribed biological therapies between 2013 to 2020. Ustekinumab was first prescribed in 2016, and risankizumab was the biologic that predominated in 2021 and onwards. Post-initiation, the probability of treatment persistence was 100% for all biological therapy at six months. At 12 months, the probability of treatment persistence was 88.2% for etanercept, 98.8% for adalimumab, 100% for ustekinumab, and 96.6% for risankizumab. At 24 months, the probability of persistence was 76.4% for etanercept, 94.3% for adalimumab, 100% for ustekinumab, and 96.6% for risankizumab. At 36 months, the probability of persistence was 70.6% for etanercept, 83.1% for adalimumab, 78% for ustekinumab, and 96.6% for risankizumab. In all cases, the most common reason for discontinuation or switching was the lack of effectiveness.

Conclusions: This study showed changing treatment patterns in psoriasis management, reflecting the introduction of newer therapeutic options over time. Notably, ustekinumab and risankizumab consistently demonstrated high treatment persistence rates, highlighting their efficacy for long-term management. Conversely, a gradual decline in persistence probabilities with etanercept and adalimumab suggests evolving considerations in treatment selection or patient responses.