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. 2015 Mar;21(3):201-9.
doi: 10.18553/jmcp.2015.21.3.201.

Patterns of medication utilization and costs associated with the use of etanercept, adalimumab, and ustekinumab in the management of moderate-to-severe psoriasis

Steven R Feldman  1 , Yang Zhao, Prakash Navaratnam, Howard S Friedman, Jackie Lu, Mary Helen Tran
Affiliations

Patterns of medication utilization and costs associated with the use of etanercept, adalimumab, and ustekinumab in the management of moderate-to-severe psoriasis

Steven R Feldman et al. J Manag Care Spec Pharm. 2015 Mar.

Abstract

Background: Dose escalations of biologic agents may be attempted in the management of moderate-to-severe psoriasis. This has implications for the real-world cost of treatment.

Objective: To examine the utilization patterns and costs associated with the use of etanercept, adalimumab, and ustekinumab among patients with moderate-to-severe psoriasis.

Methods: This was a retrospective cross-sectional study. Patients with 2 or more medical claims with a diagnosis of psoriasis (excluding psoriatic arthritis) who were enrolled in large employer-sponsored health plans (including a pharmacy benefit) in the United States from January 2007 to March 2012 were identified and extracted from the MarketScan Commercial Encounters Database. Patients aged at least 18 years were required to have 2 or more pharmacy claims for etanercept, adalimumab, or ustekinumab; the index date was the first biologic fill date. Demographics and comorbidities were identified during the 1-year pre-index period, and medication utilization and costs were evaluated in the 1-year post-index period after a titration period according to the product prescribing information (2 weeks to 12 weeks). Medication utilization parameters such as dose escalation, dose reduction, persistence, switching, discontinuation, and restarts were assessed at 6, 9, and 12 months from the end of the dose titration window.

Results: A total of 4,309 patients were included with a mean average age of 46 years, and 55% were male. Fifty-seven percent of the patients were started on etanercept, 39% on adalimumab, and 5% on ustekinumab. Patients had substantial dose escalation rates (etanercept: 41%; adalim-umab: 37%; ustekinumab: 36%, P less than 0.05) and discontinuation rates (etanercept: 35%; adalimumab: 27%; ustekinumab: 16%, P less than 0.05) over the 12-month post-titration period. Many patients also restarted the same biologic (etanercept: 37%; adalimumab: 10%; ustekinumab: 6%, P less than 0.05) or switched to another biologic (etanercept: 15%; adalimumab: 10%; ustekinumab: 5%, P less than 0.05) over the 12-month post-titration period. The persistence rates over 12 months were 19%, 53%, and 71% for etanercept, adalimumab, and ustekinumab, respectively (P less than 0.05). Close to one-third of the patients at 6 months and 39% at 12 months postdose titration experienced a dose escalation. Approximately half of the patients who experienced a dose escalation also had a discontinuation or a dose reduction over the 12-month post-titration period.

Conclusions: Over one-third of psoriasis patients experienced a dose escalation of their biologic agents, and most of the dose escalation occurred during the first 6 months. Restarting, switching, and discontinuing index biologics were also common.

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Conflict of interest statement

Support for this research was provided by Novartis Pharmaceuticals, East Hanover, New Jersey.

Navaratnam and Friedman are paid consultants for Novartis Pharmaceuticals and are employees of DataMed Solutions. Feldman is a board certified dermatologist on the faculty of the Wake Forest School of Medicine and was engaged by Novartis Pharmaceuticals as a paid clinical expert and scientific advisor for this study. Zhao is an employee of Novartis Pharmaceuticals. Tran and Lu were employees of Novartis Pharmaceuticals Corporation when the study was conducted.

Portions of this work were presented at the 2014 Annual Meeting of the Academy of Managed Care Pharmacy, April 1-4, 2014, Tampa, Florida.

Study concept and design were contributed by Feldman, Zhao, Friedman, Navaratnam, and Tran. Navaratnam and Friedman were responsible for data collection. Data were interpreted by Zhao, Lu, Tran, Navaratnam, and Friedman, with assistance from Feldman. The manuscript was written primarily by Feldman, Zhao, and Navaratnam, with assistance from Lu, Tran, and Friedman. The manuscript was revised by Zhao, Lu, and Tran, assisted by Navaratnam, Friedman, and Feldman.

Figures

FIGURE 1
FIGURE 1
Patient Selection
FIGURE 2
FIGURE 2
Dosing Patterns Among Nonswitch Patients Experiencing Dose Escalation Over 12-Month Post-Titration Period
FIGURE 3
FIGURE 3
Persistence, Restart, Switching, and Discontinuation Rates Over 12-Month Post-Titration Period a
FIGURE 4
FIGURE 4
Dose Escalation Rates in Psoriasis Patients by Various Dose Escalation Definitions a
See this image and copyright information in PMC

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