Background/Purpose: Though biologic therapies have demonstrated long-term response in randomized clinical trials for psoriatic arthritis (PsA), such patient populations and settings may not reflect the general PsA population or real-life practice patterns, e.g., switching or adding therapies for patients with inadequately controlled symptoms. To better understand long-term patterns of biologic use for PsA treatment, this study aimed to describe 2-year adherence, persistence and switching among PsA patients initiated with adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, ustekinumab or secukinumab.

Methods: Adults with ≥ 1 medical or pharmacy claim for the above biologics during 1/1/2013 – 12/31/2016 were selected from Optum’s de-identified Clinformatics® Data Mart Database. The date of the first claim was the index date. Patients were required to have ≥ 12 months pre-index and ≥ 24 months post-index continuous enrollment, with ≥2 PsA diagnoses ≥ 30 days apart during the 12-month pre-index through 12-month post-index period, and the first diagnosis occurring on or prior to the index date. Patients were excluded if they had ≥ 2 different biologics on the same day, a medical claim for rheumatoid arthritis, ankylosing spondylitis, other spondyloarthropathies, contraindications, or an index biologic filled during the 12-month pre-index period. Days’ supply from medical claims (14.8% of all claims) was imputed based on the most frequently observed days’ supply from pharmacy claims (84 days: ustekinumab; 28 or 30 days: other biologics). Baseline characteristics, adjunctive medication, number of patients who discontinued index biologic (ie, had a gap between fills of > 1.5 times the dispensed days’ supply(135 days for ustekinumab; 45 days for other biologics), and number of patients who switched to a different biologic were reported by index biologic.

Results: Of 1,109 patients included, mean (SD) age was 52.1 (12.8) years and 50.6% were female. The most common index biologics were adalimumab (43%) and etanercept (31%) [Fig 1]. During the 24-month follow-up period, 19.1% of patients persisted on their index biologic; ustekinumab had the highest persistence (27.2%) [Fig 2].The mean (SD) proportion of days covered (PDC) for index biologics was 0.47 (0.31). Of the 897 patients who discontinued their index biologic, 35.2% restarted the same biologic, 37.6% switched to a different biologic, and 33.6% discontinued without restarting or switching. The most common biologics that patients switched to were adalimumab (32%) and ustekinumab (18.4%) [Fig 3]. Of patients (n=864) who persisted with the index biologic for ≥ 90 days, 48.6% received ≥ 1 adjunctive medication during the period from 90 days post index to the end of persistence or 24 months, the most common were corticosteroids (27.7%), opioids (16.7%) and nonsteroidal anti-inflammatory drugs (13.4%).

Conclusion: In this real-world study of biologic PsA therapies,  24-month persistence ranged from 15.4%-27.2%, with ustekinumab having the highest persistence. Of patients who persisted on their index biologic for >90 days, nearly half used adjunctive therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-treatment-patterns-among-patients-with-psoriatic-arthritis-treated-with-biologic-therapies/