A Retrospective Cohort Analysis of Treatment Patterns Over 1 Year in Patients with Psoriasis Treated with Ixekizumab or Guselkumab

Abstract

Introduction: Persistence and adherence to psoriasis treatments reflect overall drug effectiveness, tolerability, and convenience. Limited data are available on the treatment patterns of ixekizumab, an interleukin (IL)-17A antagonist, vs. guselkumab, an IL-23 inhibitor. Our objective was to evaluate real-life psoriasis drug treatment patterns with ixekizumab vs. guselkumab. Methods: This retrospective observational study used United States insurance claims data from IBM Watson MarketScan Databases to analyze treatment patterns (including adherence, persistence, time on monotherapy, switching, and use of concomitant medications)for patients with 1 year, C 6 months, and up to 30 months of follow-up. Outcomes were compared between ixekizumab and guselkumab on the balanced sample after applying inverse probability of treatment weighting (IPTW). Results: Data for 1414 eligible patients (ixekizumab, N = 674 and guselkumab, N = 740) were assessed. Over the 1-year follow-up, adherence was greater for ixekizumab vs. guselkumab when evaluated by proportion of days covered C 80% [odds ratio (OR) 1.77 (95% confidence interval, 1.41, 2.21), p \ 0.001] and by medication possession ratio C 80% [OR = 1.92 (1.54, 2.38), p \ 0.001]. Persistence was longer for ixekizumab vs. guselkumab with a 60-day allowable gap [non-persistence hazard ratio (HR) (95% confidence interval): 0.80 (0.69, 0.93), p = 0.005], but there were no differences with a 90-day allowable gap [HR = 0.98 (0.83, 1.17), p = 0.850]. Results assessed in patients with C 6 months follow-up confirmed these findings. This retrospective analysis of a United States claims database used prescription refill data to estimate persistence/adherence. Conclusions: Based on real-world evidence using claims data, patients with psoriasis treated with ixekizumab had a greater adherence to and an equal or greater persistence with therapy vs. patients treated with guselkumab.

Guselkumab, Risankizumab, and Tildrakizumab in the Management of Psoriasis: A Review of the Real-World Evidence

“…Guselkumab is a human monoclonal immunoglobulin G1 (IgG1) lambda antibody directed against IL-23 that has been recently approved for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. 18 Numerous clinical trials have demonstrated the safety and efficacy of guselkumab, with the randomized double-blind phase III-controlled trials VOYAGE 1 and VOYAGE 2 assessing the guselkumab superiority vs adalimumab. 19 Moreover, the ECLIPSE study assessed Guselkumab superiority vs secukinumab in long-term efficacy based on PASI 90 and the NAVIGATE study demonstrated guselkumab superiority against ustekinumab, showing that patients treated with ustekinumab who did not achieve an IGA of 0/1 by week 16 derived significant benefit from switching to guselkumab.…”

Treatment Persistence of Ixekizumab in Adults with Moderate-to-Severe Plaque Psoriasis Participating in the Canadian Patient Support Program

“…High adherence was defined as PDC ≥ 80%. Treatment persistence was defined as being on continuous treatment over time, allowing for a maximum gap of 60 days between treatment refills (where the gap period starts on the last day of treatment supply or drug exposure from the injection and ends at the next prescription refill date) [ 23 , 32 , 33 ].…”

“…Ixekizumab, an IL-17A inhibitor, has demonstrated efficacy and safety in the UNCOVER phase III trials [ 14 – 17 ] and a real-world Canadian study [ 18 ]. Moreover, ixekizumab has shown similar [ 12 ] or better adherence (i.e., the degree or extent to which a patient complies with the prescribed interval, and dose of a dosing regimen [ 19 ]) and persistence (i.e., time from initiation to discontinuation of therapy [ 19 ]), and lower risk of discontinuation compared with other biologics [ 20 – 23 ]. Although ixekizumab has been approved for use in Canada in adult patients with moderate-to-severe PsO since 2016 [ 24 ], data from real-world Canadian studies on ixekizumab-treated patients with PsO are still limited.…”

Outcomes of Biologic Use in Asian Compared with Non-Hispanic White Adult Psoriasis Patients from the CorEvitas Psoriasis Registry

“…The advent of biologic agents over nearly two decades has dramatically enhanced the treatment of moderate to severe psoriasis. Data from randomized controlled trials (RCTs) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] have demonstrated that these agents can be highly efficacious. Yet the preponderance of evidence has been garnered from studies that have primarily included White patients.…”

“…However, while prior real-world evidence (RWE) studies have demonstrated the effectiveness of biologic therapies for psoriasis [4][5][6][7][8][9][10][11][12][13][14][15][16], there is little published data comparing the efficacy of biologics in Asian compared with other ethnicities in RWE studies. Real-world evidence is essential for providing insight into the efficacy and safety of drug treatments across all patients with psoriasis since the typical strict inclusion criteria of RCTs often exclude many patient populations seen in routine clinical care, including those with multiple comorbidities, ethnic and racial subpopulations, older adults, and patients for whom multiple biologics have failed.…”