Newer biologics show strong drug survival for psoriasis patients

For those with psoriasis treated in clinics in Denmark, ustekinumab, primarily known for being sold under the brand name Stelara—among others—showed longer drug survival than adalimumab (commonly known as Humira) and secukinumab (Cosentyx) in patients without previous biologic exposure. Additionally, bimekizumab (Bimzelx), guselkumab (Tremfya) and risankizumab (Skyrizi) performed best in patients with past exposure, according to a study published January 7 in JAMA Dermatology.

Psoriasis is a chronic inflammatory skin disease that usually requires long-term treatment with biologic medications. Over the past two decades, the number of available biologics has grown rapidly, giving clinicians more options but also making treatment decisions more complex. One way to compare how these drugs perform outside of clinical trials is through “drug survival,” which is a measure of how long patients stay on a therapy before stopping due to lack of effectiveness, side effects or other reasons.

However, clinical evidence on drug survival remains limited for newer biologics, including bimekizumab, according to the study. To address this gap, researchers from dermatology departments and university hospitals across Denmark examined the drug survival of biologic therapies used to treat psoriasis in routine clinical practice.

To do this, data from the DERMBIO registry was analyzed, which includes all patients treated with biologics for psoriasis in Denmark. The study included adult patients enrolled from the registry’s start in May 2007 through June 2025.

Patients were divided into two groups: those who had never received a biologic before, referred to as bio-naive patients, and those who had previously been treated with one or more biologics, referred to as bio-experienced patients. The researchers then looked at drug survival for commonly used biologics in each group, focusing on the risk of treatment discontinuation at one, two and five years.

In bio-naive patients, the study looked at treatment series involving adalimumab, secukinumab and ustekinumab. In bio-experienced patients, a broader range of biologics was assessed, including adalimumab, bimekizumab, brodalumab (known as Siliq in the U.S.), guselkumab, ixekizumab (Taltz), risankizumab, secukinumab and ustekinumab.

Out of the 4,438 patients with psoriasis, most were male with an average age of 45 years at the time of their first treatment. It was found that roughly one in four patients also had psoriatic arthritis.

Among bionaive patients, 3,790 treatment series were analyzed, with most involving adalimumab. After five years, the standardized risk of discontinuing ustekinumab was 37%, which was significantly lower than the risks observed with adalimumab at 51% and secukinumab at 54%. This finding suggests that patients starting their first biologic therapy were more likely to stay on ustekinumab long-term.

For bioexperienced patients, 3,403 treatment series were analyzed. At two years, the standardized risk of discontinuing ustekinumab was 39%. Three newer biologics stood out with lower discontinuation risks: bimekizumab at 27%, guselkumab at 29% and risankizumab at 25%. Other biologics didn’t show a significant advantage over ustekinumab in this group.

Based on the overall study, strengths include the use of a nationwide registry that captures a large number of biologically treated psoriasis patients in Denmark and reflects real-world clinical practice rather than controlled trial settings.

However, there are limitations in the study.

The study couldn’t account for every reason why a treatment was chosen or stopped, such as a doctor’s preference or patient factors that were not measured. Some newer biologics were also followed for a shorter time and included fewer patients.

Researchers suggest tracking how long patients stay on these drugs over time is critical as newer treatments are used more often, and that the results could help clinicians make better treatment choices for those with psoriasis.