Evaluating changes in baseline characteristics and drug utilisation pattern in patients with moderate-to-severe psoriasis: findings from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) Cohort.

Background: Since The British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) was established in 2007, numerous biologic therapies have been introduced for better management of psoriasis.

Objective: To describe the baseline demographics, disease characteristics and real-world biologic utilisation in patients entering BADBIR over time.

Methods: Patients with moderate-to-severe psoriasis registering to BADBIR between 2007 and 2024 were included. Percentages to describe categorical variables and median with inter-quartile range (IQR) were used. Year of enrolment was divided into Early (2007-2014) and Late (2015-2024) periods.

Results: As of April 2024, there were 21,407 registrations in BADBIR. Compared with the Early period, more ethnic minorities [n (%); 1,374 (12) vs. 868 (9)] were enrolled in the Late period. Shorter disease duration [median (IQR) years, 18 (10, 28) vs. 20 (11, 29)], lower severity measured using Psoriasis Area and Severity Index [median (IQR) 11 (6, 16) vs. 14 (10, 19)] and fewer patients with comorbidities [6,298 (55) vs. 5,905 (59)] were reported in the Late vs. Early period. There were 6,236 (29%) patients in the conventional and 15,171 (71%) in the biologic cohort. In the biologic cohort 8,299 (55), 3,227 (21), and 1,170 (8) switched to second, third and fourth lines of therapy, respectively. Adalimumab was the most frequently prescribed first-line therapy followed by ustekinumab and etanercept [6,591 (43), 3,349 (22) and 1,735 (11), respectively]. Despite the significant drop in utilisation over time, adalimumab remained the most frequent first-line biologic in the Late period 3,092 (35%), followed by ustekinumab 2,087 (24%) and secukinumab 1,445 (17%). However, utilisation of biologics in the subsequent lines of therapies has changed over time in that newer biologics - mainly guselkumab and risankizumab - have become the most frequent in recent years.

Conclusion: Patients registered in the Late period have less severe psoriasis, shorter disease duration and fewer comorbidities than those enrolled in the Early period. The most frequent biologics at enrolment were adalimumab and ustekinumab, however, this has changed with the introduction of new and more effective therapies. BADBIR is a rich data providing information on the management of psoriasis.