Distribution barriers may reduce biologic drug survival among patients with moderate-to-severe psoria­sis. Researchers found that patients reporting medication distribution problems were more likely to dis­continue biologic therapy, although the association appeared to be influenced by the more frequent dosing schedule of adalimumab.

Researchers conducted a retrospective cohort study using data from an ongoing real-world registry of 166 adults with severe plaque psoriasis who initiated immunobiological therapy before May 2025. Eligi­ble patients met disease severity criteria based on the Psoriasis Area Severity Index, body surface area involvement, or Dermatology Life Quality Index. The primary endpoint was drug survival, defined as the time from biologic initiation to treatment discontinuation or switching to another biologic. Secondary endpoints included disease relapse, severe adverse events leading to treatment discontinuation, infec­tions, and major adverse cardiac events.

Overall, 82 patients (49%) discontinued biologic therapy during follow-up, with disease relapse account­ing for most treatment interruptions. Adalimumab was the most frequently prescribed biologic, followed by secukinumab, ustekinumab, risankizumab, guselkumab, infliximab, and etanercept.

Distribution problems were reported by 64 patients (39%) and were associated with more frequent treatment interruption in unadjusted analyses. However, the association was no longer statistically sig­nificant following multivariable adjustment. Patients receiving adalimumab reported distribution prob­lems more often than those receiving other biologics (49% vs 29%), which the researchers suggested may reflect the medication’s more frequent dosing schedule and greater exposure to logistical disrup­tions. Adalimumab remained associated with shorter drug survival following adjustment.

A similar pattern was observed for disease relapse. Distribution problems and adalimumab use were each associated with relapse in unadjusted analyses, but the association between distribution problems and relapse was attenuated after adjustment. The researchers suggested that distribution challenges may reflect the logistical complexity of therapies requiring more frequent administration rather than functioning as an independent determinant of drug survival.

The registry also identified practical barriers to treatment. Approximately one-third of patients reported that their biologic medication had been out of stock during therapy. Additionally, 13% reported prefer­ring oral therapies because of discomfort with injections, and 22% reported disposing of biologic waste in regular household trash, suggesting opportunities to improve patient education regarding medication administration and disposal.

The investigators acknowledged that the retrospective observational design precluded causal inference and that the relatively small sample size may have limited the multivariable analyses. They noted that larger registry cohorts with longer follow-up are needed to better define the relationship between distri­bution challenges and biologic drug survival.

Overall, the findings suggest that distribution barriers may contribute to shorter biologic drug survival in health care settings where medication access is challenged, particularly for therapies requiring more fre­quent administration. As lead study author Luciana A. Ribeiro, of the University of Brasília, Brasília, Brazil, and colleagues, wrote, “In settings marked by significant stress within the distribution, storage, and ad­ministration chains for immunobiologics, distribution problems appear to negatively affect drug sur­vival.”

Disclosures: The study was funded by Bristol Myers Squibb. Two coauthors were employees of Bristol Myers Squibb, and several investigators reported financial relationships with pharmaceutical companies, including Bristol Myers Squibb. One author reported no conflicts of interest.

Source: Dermatology and Therapy