Analysis: Ustekinumab, IL-23 Inhibitors Show Higher Drug Survival in Psoriasis
Key Takeaways
Ustekinumab had the best 5-year drug survival in a study of bionaive patients with psoriasis.
In bioexperienced patients, IL-23 inhibitors bimekizumab, risankizumab, and guselkumab showed superior 2-year persistence.
Real-world registry data may help guide treatment selection in clinical practice, authors noted.
A new Danish cohort study using data from the DERMBIO registry suggests ustekinumab was linked with the best 5-year survival of comparators in bionaive patients with psoriasis.
The analysis included a total of 7,193 treatment series (3,790 bionaive and 3,403 bioexperienced) from 4,438 unique adults with psoriasis (61.2% male; mean age, 45 years). Investigators stratified outcomes by biologic experience, focusing on three agents in bionaive patients (adalimumab, secukinumab, ustekinumab) and eight agents in bioexperienced patients (including IL-23 inhibitors such as bimekizumab, guselkumab, and risankizumab). Comorbid psoriatic arthritis was present in 23.4% of the cohort.
According to the results, ustekinumab demonstrated better long-term drug survival vs adalimumab and secukinumab. Five-year standardized risk of treatment discontinuation for ustekinumab was 0.37 (95% CI, 0.33 to 0.41), compared with 0.51 (95% CI, 0.49 to 0.54) for adalimumab and 0.54 (95% CI, 0.48 to 0.60) for secukinumab.
In bioexperienced patients, IL-23 inhibitors were associated with better 2-year drug survival vs ustekinumab. Bimekizumab had the lowest 2-year standardized absolute risk of discontinuation at 0.27 (95% CI, 0.20 to 0.34), followed by risankizumab at 0.25 (95% CI, 0.15 to 0.36), and guselkumab at 0.29 (95% CI, 0.22 to 0.36). Ustekinumab's 2-year risk was 0.39 (95% CI, 0.36 to 0.43).
"These results offer insight into the performance of different biologics in the treatment of psoriasis in a routine clinical practice setting," the authors concluded.
Source: Schwarz C, et al. JAMA Dermatol. 2026. doi:10.1001/jamadermatol.2025.5205