Chronic plaque psoriasis has two distinct ages of onset: early onset (EOP; ≤40 years of age; approx. 75%); and late onset (LOP; > 40 years of age; approx. 25%). EOP and LOP appear to be clinically similar but genetically and immunologically separable. There are few clinical trial data and fewer real-world studies comparing drug survival of biologics in EOP against LOP. The aim was to investigate whether age of onset predicts drug survival in a real-world population using BADBIR, a long-term pharmacovigilance register of people on biologic therapies for psoriasis in the UK and Eire. Data from patients registering to BADBIR from 2007-2020 on either etanercept, adalimumab, secukinumab or ustekinumab with at least 6 months’ follow-up were analysed. Exposure time was calculated from initiation to the discontinuation date, and was censored at the latest follow-up or death. Patients aged 50 years and above at enrolment were categorised into EOP or LOP. Hazard ratio (HR) with 95% confidence interval (CI) was estimated using a flexible parametric model to compare EOP against LOP for drug survival of patients discontinuing therapy due to the lack of effectiveness and/or the occurrence of adverse events. Each model included age of onset (exposure), biologics (modifier) and adjusted for confounders using multiple imputed data. In total, 4677 patients were included; 3237 (69.2%) EOP vs. 1440 (30.8%) LOP. There was no significant difference in proportion of EOP and LOP patients between each biologic cohort. There was no significant difference between EOP and LOP for biologic ineffectiveness [HR (95% CI) 1.1 (1.0-1.3)] or adverse events [1.1 (0.9-1.3)]. Adalimumab and etanercept had higher probability of discontinuation due to ineffectiveness [1.6 (1.3-2.0) and 3.6 (2.9-4.5)] or adverse events [1.6 (1.2-2.1) and 2.0 (1.4-3.0)] compared with ustekinumab but similar drug survival when compared to secukinumab. There is no evidence that age of onset is a relevant predictor for overall biologic survival in psoriasis.

ESDR040 - Drug survival of biologics in patients with early vs. late onset psoriasis: an analysis from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR)

50th Annual Meeting of the European Society for Dermatological Research. VIRTUAL MEETING