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Observational Study
. 2024;16(9):611-621.
doi: 10.2217/imt-2023-0343. Epub 2024 Apr 23.

Adherence, persistence and treatment switching in psoriasis

Fiorenzo Santoleri  1 , Felice Musicco  2 , Chiara Fulgenzio  2 , Paolo Abrate  3 , Laura Pestrin  3 , Enrico Pasut  4 , Germana Modesti  4 , Romina Giannini  5 , Stefania De Rosa  5 , Mariantonietta Piccoli  6 , Grazia Mingolla  6 , Eva Zuzolo  2 , Pietro Gazzola  7 , Martina Roperti  7 , Gabriella Pieri  7 , Valentina Montresor  8 , Isabella Martignoni  8 , Marco Gambera  8 , Roberto Langella  9 , Gabriella Tinari  10 , Concetta Spoltore  11 , Cristina Roberti  12 , Letizia Di Fabio  12 , Laura Grossi  13 , Francesca Guarino  13 , Francesco De Vita  11 , Ruggero Lasala  14 , Alberto Costantini  1
Affiliations
Observational Study

Adherence, persistence and treatment switching in psoriasis

Fiorenzo Santoleri et al. Immunotherapy. 2024.

Abstract

Aim: This study aims to investigate drug utilization patterns in the treatment of psoriasis (PsO) from 1 to 5 years in a real-life setting with Adalimumab (Ada), Etanercept (Eta), Ustekinumab (Ust), Golimumab (Gol), Ixekizumab (Ixe), Secukinumab (Sec) and Apremilast (Apr). Materials & methods: Data from an observational study were used to calculate adherence using the Proportion of Days Covered (PDC) method and persistence. Results & conclusion: Treatment adherence was found to be good for all the drugs studied across all years of analysis, while persistence was suboptimal, showing a marked decrease from the third year of study onward. In the treatment of PsO, greater attention needs to be paid to treatment persistence.

Keywords: biologic and targeted synthetic disease-modifying antirheumatic drugs; discontinuation; drug utilization research; medication adherence; persistence; psoriasis; real-life analysis; treatment switching.

Plain language summary

This summary explains that when a patient follows their doctor's medication instructions and continues using the same medication over time to treat a condition like psoriasis, they can expect safer and more effective outcomes. This study examined these aspects to assess how different medications perform over the long term and to explore ways to improve their prescription. The findings highlight that the main issue is not so much in following instructions but in continuing to use the same medication throughout the treatment duration. Raising awareness among healthcare professionals about these issues is crucial to help patients maintain consistent therapy over time and improve their care pathway.

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Conflict of interest statement

All authors report no conflicts of interest, with the exception of Enrico Pasut, who provided consultancy services for Biogen in 2020. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Computation of patients discontinuing. The cut-off date to identify discontinuing patients was set at 31st December 2020, the last useful reporting date. Patients with a continuation date beyond 31 December 2020 were considered still in therapy; otherwise, they were marked as having discontinued.
Figure 2.
Figure 2.
Flowchart analysis. Of the 1620 patients analyzed, 1347 were in the first line of treatment. From these, 14 minors, 40 on Brodalumab, 11 on Certolizumab, 6 on Dimethyl fumarate and 17 on Golimumab were excluded due to low sample sizes. A further 175 patients were excluded due to persistence of less than 1 year, thereby categorizing the patients based on their minimum treatment duration.
Figure 3.
Figure 3.
Persistence of treatment at 1, 2, 3, 4 and 5 years. Persistence of treatment at (A) 1, (B) 2, (C) 3, (D) 4, (E) 5 years. Using Kaplan-Meier curves, the persistence of patients divided based on treatment duration as shown in Figure 2 is graphed. The graphs order the drugs based on treatment persistence.
Figure 4.
Figure 4.
Comparison of the persistence of naive patients with experienced patients over time. (A) 1, (B) 2, (C) 3, (D) 4, (E) 5 years.
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References

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