18189 In-office Administration Improves the Drug Survival of Ustekinumab for Chronic Plaque Psoriasis Compared with Self-Administration: A Single-Institution Retrospective Chart Review

Ustekinumab is an interleukin-12/23 inhibitor approved for treatment of chronic plaque psoriasis that is administered as a subcutaneous injection every 12 weeks. Ustekinumab can be self-administered or administered in-office depending on insurance coverage and patient preference. Previous studies have demonstrated that adherence to ustekinumab is superior when it is administered in-office; however, no studies have evaluated whether in-office administration improves ustekinumab’s drug survival, a real-world surrogate for tolerability and efficacy. To evaluate whether in-office administration of ustekinumab improves drug survival, we performed a single institution retrospective chart review to identify patients receiving ustekinumab for psoriasis. Patients were excluded if they 1) were lost to follow-up, 2) initiated ustekinumab prior to being seen within our department, and/or 3) had received ustekinumab in-office and had self-administered it. We identified 380 eligible patients, 225 (59%) of whom received ustekinumab in-office. Patients receiving ustekinumab in-office were older and more likely to be biologic naïve than patients that self-administered ustekinumab. Rates of primary failure and adverse events leading to discontinuation were similar among the two groups. Kaplan-meier methodology was used to assess drug survival. Even when adjusting for age, biologic naivety, and other patient factors, in-office ustekinumab demonstrated superior drug survival compared with self-administered ustekinumab (P = .034) with an average quartile survival time of 56 months (95% CI 34 to +) for in-office ustekinumab versus 39 months for self-administered ustekinumab (95% CI 14-55). These findings suggest that in-office administration of ustekinumab may improve ustekinumab’s survival. Presumably other similarly infrequently dosed biologics may benefit from in-office administration.