Background/Purpose: Long-term real-world treatment patterns of psoriasis patients are not well characterized, especially those with comorbid psoriatic arthritis (PsA). This study examined the treatment patterns among psoriasis patients who newly initiated a biologic or apremilast (APR) by PsA status.

Methods: Using a large US claims database, adult patients with psoriasis were classified into 5 mutually exclusive cohorts based on their initial index medication between 01/01/2015 and 08/31/2018: secukinumab (SEC), adalimumab (ADA), ustekinumab (UST), etanercept (ETA), or APR. Eligible patients had no index medication use in the 12-month pre-index period, and had continuous medical and pharmacy benefits in the 12-month pre-index and 24-month post-index periods. Subgroups were created by the presence of a PsA diagnosis over the 12-month pre-index period. Rates of discontinuation, adherence (proportion of days covered [PDC], adherent if PDC ≥0.8), non-persistence, and switching were compared between patients with and without PsA within each cohort. Treatment gaps were defined as 4 weeks for ETA and APR, 8 weeks for ADA, 10 weeks for SEC, and 18 weeks for UST.

Results: A total of 7,773 psoriasis patients were included: 275, 2,684, 910, 1,063, and 2,841 patients for SEC, ADA, UST, ETA, and APR, respectively, and the proportions of patients with PsA were 35.3%, 35.1%, 22.0%, 45.7%, and 24.8%, respectively. Over the 24-month post-index period, discontinuation rates for patients with and without PsA were: SEC: 54.6% vs. 43.8%; ADA: 48.3% vs. 53.0%; UST: 52.5% vs. 34.4%; ETA: 38.1% vs. 45.4%; and APR: 47.7% vs. 43.4% (all p< 0.05 except SEC). Adherence rates were: SEC: 30.9% vs. 34.8%; ADA*: 30% vs. 25.5%; UST: 17.5% vs. 23.9%; ETA*: 26.5% vs. 16.8%; and APR: 22.4% vs. 22.9% (*p< 0.05). Non-persistence rates were: SEC: 69.1% vs. 65.7%; ADA: 71% vs. 74.4%; UST*: 68.5% vs. 55.5%; ETA*: 82.1% vs. 90.3%; and APR: 86.6% vs. 84.8% (*p< 0.05). Overall switching rates were high for all groups (24.8%–55.1%, all p< 0.05 except ETA).

Conclusion: About 22%–46% moderate-to-severe psoriasis patients who initiated biologics or APR had comorbid PsA. Over 24-month post-index period, overall adherence was poor and discontinuation, non-persistence, and switching were high for all groups. Maintaining long-term therapy is still a challenge for psoriasis patients. Treatments that overcome the hurdle of poor adherence to self-administration may be helpful.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-treatment-patterns-of-biologics-and-apremilast-among-patients-with-moderate-to-severe-plaque-psoriasis-by-psoriatic-arthritis-status/