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. 2022 Sep;12(9):2087-2103.
doi: 10.1007/s13555-022-00775-1. Epub 2022 Aug 10.

Treatment Patterns for Targeted Therapies, Non-Targeted Therapies, and Drug Holidays in Patients with Psoriasis

April Armstrong  1 , Qian Xia  2 , Anand Rojer John  3 , Vardhaman Patel  2 , Lauren Seigel  2
Affiliations

Treatment Patterns for Targeted Therapies, Non-Targeted Therapies, and Drug Holidays in Patients with Psoriasis

April Armstrong et al. Dermatol Ther (Heidelb). 2022 Sep.

Abstract

Introduction: We aimed to evaluate US treatment patterns and, more specifically, switch patterns among patients with psoriasis (PsO) who initiated treatment with targeted therapy (TT) and subsequently switched to another therapy.

Methods: This retrospective study used IBM® MarketScan® Commercial and Medicare Databases (1/1/2006-3/31/2020) to evaluate treatment patterns in biologic- and apremilast-naive patients with PsO. TT included apremilast, adalimumab, etanercept, infliximab, ustekinumab, or other biologics (certolizumab pegol, secukinumab, brodalumab, ixekizumab, guselkumab, or tildrakizumab). Adults with ≥ 1 prescription for a TT, ≥ 2 PsO claims separated by ≥ 1 day on or before the index date (date of first TT prescription), and continuous medical and pharmacy enrollment for 1 year before and 2 years after the index date were eligible. Non-targeted therapy (NTT) was defined as non-targeted oral systemic treatment, topical treatment, phototherapy, or no treatment. Kaplan-Meier (KM) analysis was used to estimate time to reinitiation of TT (24-month continuous enrollment post-index was not required).

Results: A total of 11,526 patients with PsO were included; mean [standard deviation (SD)] age and Charlson Comorbidity Index score were 48.3 (12.8) years and 0.9 (1.43), respectively. During the follow-up, 69.2% of the patients were treated with NTT. Median time to first NTT, for those who received NTT, was 205 days (longest: adalimumab, 252 days). Among patients who switched to NTT after initiating treatment with TT, 52.6% reinitiated treatment with TT (least common: apremilast, 45.6%), with a median time to reinitiation of 106 days (longest: other biologics, 136 days). For all patients on NTT, the probability of reinitiating any TT was 60.7% at 24 months.

Conclusions: PsO treatment is often cyclical in nature. Patients frequently experience drug holidays or transition back to TT after using NTT. The consideration of real-world treatment patterns in future economic models may provide new insights into the clinical effectiveness and value of PsO treatments.

Keywords: Biologics; Epidemiology; IL inhibitor; Observational study; PDE-4 inhibitor; Psoriasis; TNF inhibitor; Treatment switch.

Plain language summary

Psoriasis is a chronic inflammatory skin disease that affects 3.0% of adults or an estimated 7.56 million Americans. The most common type of psoriasis is called plaque psoriasis because of its appearance with red patches and silvery scales on the skin. A major concern of medical providers is that not all patients continue their treatment as prescribed. Many patients discontinue, switch, and often restart treatment. To develop effective psoriasis treatment plans for shared decision-making among medical providers and patients, it is important to look at how treatments are used in the real world. This can be done by conducting studies using insurance claims data from healthcare insurance providers. In this study, we evaluated treatment patterns and, more specifically, patterns in changes of treatment in US patients who began their psoriasis treatment with a targeted therapy (biologics or apremilast) and then changed to another therapy. We found that patients often took drug holidays (days with no treatment) and returned back to using a targeted therapy after using a non-targeted therapy (e.g., other oral therapy, topical treatment, phototherapy, or no treatment). Findings from this real-world study may support future studies on the clinical effectiveness and value of current and future treatments for psoriasis—especially within these targeted to non-targeted transitions.

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Figures

Fig. 1
Fig. 1
Study schema
Fig. 2
Fig. 2
Percentage of patients receiving NTT by index therapy. The date of the first prescription of a branded systemic treatment (index therapy) in the index period is the index date. Follow-up time was any time in the 24 months from the index date, and all patients had at least 24 months of follow-up
Fig. 3
Fig. 3
Median time to first NTT by index therapy. The date of the first prescription of a branded systemic treatment (index therapy) in the index period is the index date. Follow-up time was any time in the 24 months from the index date
Fig. 4
Fig. 4
Percentage of patients reinitiating any TT after NTT by index therapy. The date of the first prescription of a branded systemic treatment (index therapy) in the index period is the index date. Follow-up time was any time in the 24 months from the index date
Fig. 5
Fig. 5
Median time to NTT and reinitiating TT by index therapy. Index therapy is the first prescription of a branded systemic treatment. ITT index targeted therapy, NTT non-targeted therapy. Horizontal black lines indicate a treatment switch. Top black lines (above the pink sections) indicate a return to ITT after NTT
Fig. 6
Fig. 6
Kaplan–Meier curve for time to transition back to any TT
Fig. 7
Fig. 7
Sankey diagram of treatment sequences between targeted and non-targeted therapies. Non-targeted combinations: phototherapy + oral systemic; phototherapy + oral systemic + topical; phototherapy + topical; oral systemic + topical. NTT non-targeted therapy, TT targeted therapy
Fig. 8
Fig. 8
Patient flow through treatment sequences between targeted and non-targeted therapies. All percentages = patients with same TT reinitiation (2TT)/patients with TT initiation (1TT). 1TT first therapy, 2T second therapy, NTT non-targeted therapy, T therapy, TT targeted therapy
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References

    1. Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–1072. doi: 10.1016/j.jaad.2018.11.057. - DOI - PubMed
    1. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis prevalence in adults in the United States. JAMA Dermatol. 2021;157(8):940–946. doi: 10.1001/jamadermatol.2021.2007. - DOI - PMC - PubMed
    1. Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA. 2020;323(19):1945–1960. doi: 10.1001/jama.2020.4006. - DOI - PubMed
    1. Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019;80(4):1073–1113. doi: 10.1016/j.jaad.2018.11.058. - DOI - PubMed
    1. Institute for Clinical and Economic Review. Targeted immunomodulators for the treatment of moderate-to-severe plaque psoriasis: effectiveness and value. Condition update (final evidence report). Boston: Institute for Clinical and Economic Review; 2018.