The chronic skin condition of moderate-to-severe plaque psoriasis (PsO) affects 1.7 million Americans and can substantially decrease patient quality of life and increase overall healthcare costs. Biologics—such as secukinumab (SEC), ixekizumab (IXE), adalimumab (ADA), ustekinumab (UST), and etanercept (ETA)—and the phosphodiesterase-4 enzyme inhibitor apremilast (APR) are frequently used to treat PsO; however, long-term treatment patterns are not well identified. To better characterize moderate-to-severe PsO treatment patterns, Feldman and colleagues studied patterns of treatment adherence, nonpersistence, discontinuation, switching, and re-initiation experienced by patients who had recently started the PsO therapeutics listed above.1
Feldman and colleagues used data from commercial and Medicare claims databases to select patients who had started SEC, IXE, ADA, UST, ETA, or APR between January 1, 2015, and August 31, 2018. (Those with Medicare had private Medicare supplemental coverage.) Patient selection criteria included no previous use of the study therapeutic and no history of cancer or HIV during the 12 months before starting the therapeutic. Using data from the 12 months leading up to the day of therapeutic initiation, Feldman and colleagues identified patient age, sex, baseline comorbidities, and baseline medications. Then, at 12 months, 18 months, and 24 months after therapeutic initiation, they evaluated rates of adherence, nonpersistence, discontinuation, switching, and re-initiation for SEC, IXE, ADA, UST, ETA, or APR. IXE was examined over only the 12-month period because of the small sample size.1
Adherence was measured as the proportion of days covered being greater than or equal to 0.8. Nonpersistence was indicated by no refill within a treatment gap (4 weeks for ETA and APR; 8 weeks for ADA; 10 weeks for SEC; and 18 weeks for UST). Discontinuation was defined as no claim for the therapeutic after a gap in treatment. Switching could involve discontinuing the initial therapeutic and initiating a biologic (or different biologic, if initial therapeutic was a biologic), APR, or oral medication with or without a treatment gap. Re-initiation was identified on the basis of claims involving the initial medication after a treatment gap.1
Adherence rates for the therapeutics were low across the 24-month period following initiation: At 12 months, adherence rates ranged from 30% to 54%; at 18 months, 25% to 40%; and at 24 months, 21% to 33%. Nonpersistence was high: At 12 months, nonpersistence ranged from 36% to 71%; at 18 months, 49% to 81%; and at 24 months, 58% to 87%. At 24 months, 38% to 51% of patients had discontinued treatment, 17% to 42% had switched treatment, and 19% to 44% had re-initiated treatment. These trends were similar at 12 and 18 months.1
The results of this analysis showed that medication adherence rates were low and many patients did not persist with treatment for PsO. Also, patients frequently stopped therapy, restarted therapy, or switched to another therapy. Feldman and colleagues note that there is a need for additional PsO therapeutics that could offer long-term control within an outpatient setting and therefore could increase rates of adherence.1
1. Feldman SR, Zhang J, Zhao Y, et al. Apremilast treatment patterns in moderate-to-severe plaque psoriasis. Poster presented at: AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 25-28, 2019; San Diego, CA.