Background/Purpose: Prior research reported that patients (pts) with psoriatic arthritis (PsA) treated with guselkumab (GUS) were 1.5x more likely to remain persistent with on-label treatment (tx) at 24 months (mo) vs those treated with subcutaneous (SC) interleukin-17A inhibitors (IL-17Ai; secukinumab or ixekizumab; Mease et al., CCR West 2024). However, there is a need for long-term real-world evidence comparing on-label tx persistence among biologic-naïve and biologic-experienced pts with active PsA initiating GUS vs SC IL-17Ai.

Methods: Adults with active PsA and ≥1 claim for GUS or SC IL-17Ai were selected from the IQVIA PharMetrics® Plus database (1/1/2011–6/30/2023; first claim = index date) to compare tx persistence among biologic-naïve and biologic-experienced pts. Pts were classified as biologic-experienced if they had ≥1 claim for PsA-indicated biologic DMARD (bDMARD) during the period of continuous insurance eligibility prior to the index date, and biologic-naïve otherwise. Pts had ≥12 mo of continuous insurance eligibility and no claims for confounding diseases/study medications prior to index date. On-label persistence was defined as no tx discontinuation and no dose modification per FDA-approved label. Baseline characteristics (12 mo prior to index date) between GUS and SC IL-17Ai cohorts were balanced separately for biologic-naïve and biologic-experienced pts using propensity score overlap weighting. For both populations, on-label persistence through 24 mo was compared between tx cohorts using weighted Kaplan-Meier (KM) curves and weighted Cox proportional hazards model.

Results: Among biologic-naïve pts, 362 GUS pts (mean age: 49.5 years [y]; 59.9% female [F]) and 845 SC IL-17Ai pts (mean age: 50.1y; 55.9% F) were included. Among biologic-experienced pts, 487 GUS pts (mean age: 49.9y; 59.5% F) and 1,756 SC IL-17Ai pts (mean age: 49.5 y; 60.7% F) were included. Weighted baseline characteristics were well-balanced between both tx cohorts among biologic-naïve and biologic-experienced pts. Among biologic-naïve pts, median time-to-discontinuation was 22.4 (GUS) vs 14.9 mo (SC IL-17Ai). For biologic-experienced pts, median time-to-discontinuation was 18.1 (GUS) vs 11.6 mo (SC IL-17Ai). Weighted KM on-label persistence rates among biologic-naïve pts at 6, 12, 18, 24 mo: 85.7%, 72.6%, 62.6%, 47.5% (GUS) vs 70.6%, 55.2%, 45.2%, 40.3% (SC IL-17Ai); for biologic-experienced pts, weighted KM on-label persistence rates: 76.7%, 54.4%, 51.0%, 43.3% (GUS) vs 67.1%, 48.6%, 39.3%, 32.0% (SC IL-17Ai) (all log-rank p≤0.01). Pts initiating GUS were significantly more likely to be persistent at 24 mo among both biologic-naïve (HR: 1.70, 95% CI: 1.32–2.20; p< 0.001) and biologic-experienced populations (HR: 1.33, 95% CI: 1.11–1.59; p=0.002).

Conclusion: This real-world study assessing long-term tx persistence among pts with active PsA in the US showed that GUS was associated with significantly greater rates of on-label tx persistence through 24 mo among both biologic-naïve and biologic-experienced pts, compared to pts using SC IL-17Ai. Sustained long-term on-label use may enhance disease management, leading to better functional status and quality of life.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-on-label-treatment-persistence-through-24-months-in-biologic-naive-and-biologic-experienced-patients-with-psoriatic-arthritis-comparison-of-guselkumab-versus-subcutaneous-interleukin-17a-i/