Drug survival reflects a drug's effectiveness, safety and tolerability. We assessed the drug survival of biologics used to treat psoriasis in a prospective national pharmacovigilance cohort (BADBIR). The survival rates of the first course of biologics for 3523 biologic-naïve patients with chronic plaque psoriasis were compared using survival analysis techniques, and predictors of discontinuation analysed using a multivariate Cox proportional hazards model. Data for patients on adalimumab (n=1879), etanercept (n=1098), infliximab (n=96) and ustekinumab (n=450) were available. The overall survival rate in the first year was 77%, falling to 53% in the third year. Multivariate analysis showed female gender (HR 1.22; 95% CI:1.09,1.37), being a current smoker (HR 1.19; 95% CI:1.03,1.38), and a higher baseline DLQI (HR1.01; 95% CI:1.00,1.02) were predictors of discontinuation. Presence of psoriatic arthritis (HR 0.82; 95% CI:0.71,0.96) was a predictor for drug survival. As compared to adalimumab, patients on etanercept (HR 1.63; 95% CI:1.45,1.84) or infliximab (HR 1.56; 95%CI:1.16,2.09) were more likely to discontinue therapy, whilst patients on ustekinumab were more likely to persist (HR 0.48; 95% CI:0.37,0.62). After accounting for relevant covariates, ustekinumab had the highest first course drug survival. The results of this study will aid clinical decision making when choosing biologic therapy for psoriasis patients.Journal of Investigative Dermatology accepted article preview online, 08 June 2015. doi:10.1038/jid.2015.208.