Immunobiological Therapy in Moderate-to-Severe Psoriasis: A Retrospective Cohort Study Investigating the Effects of Inadequate Therapeutic Compliance on Drug Survival

Evaluating psoriasis care in Brazil, a country characterized by its vast geographical expanse, may provide valuable lessons for healthcare systems globally. National research has revealed that individuals receiving biologic treatments in Brazil exhibit lower drug survival rates than individuals from other countries, highlighting challenges that may be applicable elsewhere. The aim of this study was to determine whether distribution problems, poor adherence, and improper storage of immunobiological therapeutics are significant risk factors for reduced drug survival during psoriasis treatment. In this retrospective cohort study, patients diagnosed with psoriasis who were receiving immunobiological therapy were enrolled in a real-world registry. Drug distribution, adherence, and storage problems were evaluated as risk factors. The primary endpoint was drug survival. Relative risk (RR) and Kaplan‒Meier analyses were used to assess associations, and multivariable analysis was performed via accelerated failure time modeling. Among 166 patients, 82 (49.40%) discontinued treatment. Adalimumab was the most frequently administered biologic (n = 77), followed by secukinumab (n = 40), risankizumab (n = 9), guselkumab (n = 8), infliximab (n = 6), etanercept (n = 4), and ustekinumab (n = 19). Bimekizumab, brodalumab, and certolizumab pegol were each used by one patient. Distribution problems increased the risk of treatment interruption (RR = 1.45, 95% confidence interval [CI]: 1.07–1.95). After adjustment, the adverse impact of distribution problems diminished, most likely because of adalimumab’s more frequent dosing schedule. Adalimumab use was linked to shorter drug survival (hazard ratio = 1.51, 95% CI: 1.01–2.27). Postinjection management also raised concerns: 22.23% of patients reported disposing of biologic waste in the regular trash. In settings marked by significant stress within the distribution, storage, and administration chains for immunobiologics, distribution problems appear to negatively affect drug survival. The use of therapies with longer dosing intervals or oral medications may help overcome these barriers. This study examined how people in Brazil with psoriasis, a long-term skin condition, receive important medicines called immunobiological therapies. Brazil is a very large country, which sometimes makes it difficult for patients to get their medication, maintain their treatment, or store the medicines properly. The researchers investigated whether these difficulties led to patients stopping their treatment earlier than expected. They followed 166 patients who were taking these medicines and found that nearly half of them (49.40%) stopped their treatment. Problems with getting the medicine delivered were linked to patients interrupting their treatment. However, this effect was lessened for those using adalimumab, a drug that needs to be taken more often. The study suggests that issues with distribution can make it more difficult for people to adhere to their psoriasis treatment. Using medicines that are taken less frequently, or oral medicines, could help people overcome these difficulties and continue their therapy for longer. This research highlights the importance of ensuring medicines are easy to access and use, especially in countries with large distances between patients and healthcare services.