Evaluating changes in baseline characteristics and drug-utilization 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 the better management of psoriasis.

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

Methods: Patients with moderate-to-severe psoriasis registered in BADBIR between 2007 and 2024 were included. Percentages were used to describe categorical variables and the median with interquartile range (IQR) for continuous variables. The 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 minority ethnic groups [1374/11 383 (12.1%) vs. 868/10 024 (8.7%)] were enrolled in the Late period. Shorter disease duration [median years, 18 (IQR 10-28) vs. 20 (11-29)], lower severity measured using Psoriasis Area and Severity Index [median 11 (IQR 6-16) vs. 14 (IQR 10-19)] and fewer patients with comorbidities [6298/11 383 (55.3%) vs. 5905/10 024 (58.9%)] were reported in the Late vs. the Early period. There were 6236 (29.1%) patients in the conventional cohort and 15 171 (70.9%) in the biologic cohort from 2007 to 2024 (total N = 21 407). Out of 15 171 individuals in the biologic cohort, 8299 (54.7%), 3227 (21.3%) and 1170 (7.7%) switched to second, third and fourth lines of therapy, respectively. In 15 171 individuals (2007-2024), adalimumab was the most frequently prescribed first-line therapy, followed by ustekinumab and etanercept [6576 (43.4%), 3349 (22.1%) and 1750 (11.5%), respectively]. Despite the significant drop in utilization over time, adalimumab remained the most frequent first-line biologic in the Late period 3092/8716 (35.5%), followed by ustekinumab 2087/8716 (23.9%) and secukinumab 1445/8716 (16.6%). However, utilization of biologics in the subsequent lines of therapies has changed over time in newer biologics, with mainly guselkumab and risankizumab becoming the most frequent in recent years.

Conclusions: 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 biologics. BADBIR is a rich data source providing information on the management of psoriasis.