Examining Treatment Patterns of Patients With Moderate-to-Severe Plaque Psoriasis

Allison Inserro

A recent study examined prescription claims databases to determine treatment patterns of patients with moderate-to-severe psoriasis who started therapy with 1 of 5 drugs by later status of whether they had psoriatic arthritis (PsA) or not.

Up to 40% of patients with psoriasis develop PsA, which leads to permanent joint deformities, particularly when left untreated. Compared with patients with psoriasis who do not have PsA, patients with psoriasis and PsA have greater disease burdens and different treatment patterns.

Many biologics, as well as apremilast (APR), an oral phosphodiesterase 4 inhibitor, are widely used to treat moderate-to-severe psoriasis, one of the most prevalent immune-mediated diseases in the United States, affecting as many as 7.5 million people. However, therapy disruptions are common, including escalations and reductions in dose, dose reductions, switches, discontinuations, and restarts.

In this study, researchers used claims from the IBM MarketScan Commercial and Medicare Supplemental Databases and selected patients beginning secukinumab (SEC), adalimumab (ADA), ustekinumab (UST), etanercept (ETA), or APR between between January 2015 and August 2018. Metabolic comorbidities included diabetes, hypertension, hyperlipidemia, coronary heart disease, obesity, and anxiety.

Other medications noted in the claims included antidepresssants, cardiovascular disease drugs, antihypertensives, topical steroids, methotrexate, other biologics, and systemic steroids.

Demographic and clinical characteristics were measured at index and during the 12-month preindex period, respectively. Adherence, nonpersistence, discontinuation, switching, and reinitiation were examined over 12-, 18-, and 24-month postindex periods. Switching was defined as 4 possible methods: index on a biologic and initiating a biologic different from the index medication with or without a treatment gap; index on a biologic and starting APR/oral medication after a treatment gap; index on APR and starting any oral medication with a treatment gap; or index on APR and beginning a biologic with or without a treatment gap

Treatment gaps were defined as 4 weeks for ETA and APR, 8 weeks for ADA, 10 weeks for SEC, and 18 weeks for UST. Adherence was defined as proportion of days covered less than or equal to 0.8. Nonpersistence was defined as there being no refill within the predefined treatment gaps, and discontinuation was defined as there being no claim for the index medication after a treatment gap.

Reinitiation was defined as a subsequent claim for the index medication after a treatment gap.

At the index date, there were 3471 claims for SEC, 91,595 for ADA, 12,909 for USR, 46,753 for ETA, and 16,790 for APR.

The researchers said that about 16% to 46% of patients who started biologics or APR had PsA. Both groups had poor overall adherence and high rates of switching; patients who self-administered found it challenging to maintain long-term therapy. 

The results showed that patients without PsA who were treated with UST, a biologic that inhibits interleukin (IL)-23 and IL-12, had better persistence, lower discontinuation, and lower switching. IL-12 and IL-23 modulate lymphocyte function, including T-helper (Th) 1 and Th17 cells.

Feldman SR, Zhang J, Martinez D, et al. Treatment patterns of biologics and apremilast among patients with moderate to severe plaque psoriasis by metabolic syndrome status. Presented at: ISPOR 2019 Annual Meeting; May 18-22, 2019; New Orleans, LA. Poster 138.
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