Telehealth visits were just as effective as in-person visits at managing patients initiating apremilast.
During the COVID-19 pandemic, patients with psoriasis and psoriatic arthritis (PsA) initiating apremilast had similar medication adherence with telehealth visits compared with in-person visits.
“This study identified a number of factors associated with adherence and initiating apremilast via a telehealth visit,” wrote the researchers of the study. “Overall, the pre- and post-pandemic cohorts in our analysis had similar medication adherence and persistence.”
This retrospective observational analysis study was published in Dermatology and Therapy.
Apremilast is an osmotic release (OSM)–targeted phosphodiesterase-4 (PDE4) inhibitor indicated for the treatment of plaque psoriasis, active PsA, and Bechet’s disease with oral ulcers. Although studies in other disease areas have shown telehealth can be effective in managing patients both prior to and during the COVID-19 pandemic, it was unknown how telehealth impacted adherence in patients with psoriasis or PsA treated with apremilast.
Using data on patients living in the United States who newly initiated apremilast between April 1, 2020, and June 30, 2020, were included in the study. Patients were categorized as either having a telehealth or in-person visit when apremilast was first prescribed. Patient adherence was defined as the proportion of days covered, with 0.80 days or more showing high adherence. Additionally, persistence was described as having apremilast available to take without a 60-day gap during follow up.
Patients were included in the study if they were at least 18 years old, had continuous enrollment for at least 6 months prior to and 6 months after the index date, and had either psoriasis or PsA within 90 days prior to or on the index date.
A total of 505 patients were enrolled in the study, in which 141 had a telehealth visit and 364 patients initiated apremilast in an in-person visit. Of these patients, the mean age was 47.6 years, 57.8% were female, and 79.6% had psoriasis.
Telehealth visits were more likely among patients living in the Northeast (odds ratio [OR], 3.31; 95% CI, 1.63-6.71), Western regions in the United States (OR, 2.52; 95% CI, 1.07-5.93), among patients with a prescribing rheumatologist (OR, 2.27; 95% CI, 1.10-4.68), and among those with any baseline telehealth visit (OR, 1.91; 95% CI, 1.20-3.04).
Furthermore, patients who had a telehealth visits had similar mean proportion of days covered (0.695 days) compared with patients who had an in-person visit (0.728 days) (P = 0.272).
After follow-up, 54.3% of all patients had high adherence and 65.1% were persistent. Additionally, after adjusting for confounding factors, patients who initiated apremilast in a telehealth visit had similar full adherence (OR, 0.80; 95% CI, 0.52-1.21) and persistence like that of patients who initiated apremilast in an in-person visit.
The researchers acknowledged some limitations to the study, such as using administrative claims data, which lacked important clinical details and patient perspectives related to disease severity and symptoms, only being able to evaluate medication adherence by prescription refills, and that the claims data used were generated for reimbursement, rather than research.
Despite these limitations, the researchers of the study believe the study shows similar adherence and persistence among a commercially and Medicare insured patients initiating apremilast in the telehealth and in-person setting.
“Apremilast initiation is a simple process requiring no pre-screening or laboratory monitoring,” wrote the researchers. “These findings suggest that patients with [psoriasis] and patients with PsA initiating apremilast may be effectively managed via telehealth visits, although future research is needed to assess the impact of additional clinical and treatment factors (such as type of psoriasis and concomitant therapy) on effective management via telehealth.”
Das AK, Chang E, Paydar C, Broder MS, Orroth KK, Cordey M. Apremilast adherence and persistence in patients with psoriasis and psoriatic arthritis in the telehealth setting versus the in-person setting during the COVID-19 pandemic. Dermatology and Therapy. 2023;13(9):1973-1984. doi:10.1007/s13555-023-00967-3