Early Real-World Experience of Tofacitinib for Psoriatic Arthritis: Data from a United States Healthcare Claims Database

Abstract

Introduction This study characterized real-world demographic and baseline clinical characteristics, as well as treatment persistence and adherence, in patients with psoriatic arthritis (PsA) who had newly initiated tofacitinib treatment. Methods This retrospective cohort study included patients aged 18 years or older in the IBM MarketScan™ US database with at least one tofacitinib claim (first = index) between December 14, 2017 and April 30, 2019; PsA diagnoses on/within 12 months pre-index; and no diagnoses of rheumatoid arthritis any time pre-index. Patients were continuously enrolled for 12 months pre-index and 6 months post-index, with no pre-index claims for tofacitinib. Patient demographic and clinical characteristics on the day of index, and history of advanced treatments (including tofacitinib monotherapy or combination therapy), were recorded. Outcomes at 6 months post-index included tofacitinib persistence (less than 60-day gap without tofacitinib treatment) and adherence (proportion of days covered [PDC] and medication possession ratio 80% or higher). Results Of the 10,354 patients with tofacitinib claims within the study period, 318 patients with PsA met the inclusion criteria. More than 60% of patients received tofacitinib monotherapy post-index, with a mean duration of PsA of 760.5 days at index. For patients who received tofacitinib combination therapy post-index, methotrexate was the most common concomitant conventional synthetic disease-modifying antirheumatic drug. At 6 months post-index, persistence was similar in patients receiving tofacitinib monotherapy (69.8%) versus combination therapy (73.1%); adherence (as measured by PDC ≥ 0.8) was numerically lower in patients receiving tofacitinib monotherapy (56.8%) versus combination therapy (65.5%). Conclusions This analysis of US-based claims data described patients who had newly initiated tofacitinib treatment an average of 2 years after PsA diagnosis, with approximately two-thirds of patients receiving tofacitinib monotherapy. Observed rates of tofacitinib persistence were similar across patients who received tofacitinib monotherapy and combination therapy 6 months after initiation; adherence rates were numerically lower in patients receiving monotherapy. Graphical Abstract

Post-Marketing Safety Surveillance of Tofacitinib over 9 Years in Patients with Psoriatic Arthritis and Rheumatoid Arthritis

“…Off-label use was the second most frequently reported AE for PsA, which might be attributable to use as monotherapy (tofacitinib is approved for PsA in combination with methotrexate or nonbiologic DMARDs, depending on the country). A recent analysis of US claims data found that 62.6% of patients treated with tofacitinib for PsA were receiving monotherapy [ 52 ]. Alternatively, off-label use may represent utilization of a higher dose, such as 10 mg BID, which is not approved for PsA, and is approved for RA in Russia and Botswana (and formerly Switzerland, until 2020).…”

Real-world evaluation of persistence, effectiveness and usage patterns of tofacitinib in treatment of psoriatic arthritis in Australia

“…The European Alliance of Associations for Rheumatology (EULAR) recommendations for the pharmacological treatment of PsA however continue to place MTX and other csDMARDs at the top of the treatment algorithm [ 23 ]. Although limited data comparing tofacitinib monotherapy vs combination therapy exist, a recent real-world study from the United States of America reported that persistence rates for monotherapy and combination tofacitinib therapy in PsA were similar after 6 months of treatment [ 24 ]. Furthermore, side effects from methotrexate such as fatigue commonly lead to discontinuation [ 25 ] and thus in practice treatment with b/tsDMARD monotherapy is common, as was observed in our study.…”

Patient-Level Exposure to Actionable Pharmacogenomic Medications in a Nationally Representative Insurance Claims Database

“…Medications filled include only those filled through insurance and do not include medications filled out-of-pocket or out-of-network. While not a direct measure of whether patients take the medications they fill, claims data are frequently used to measure medication exposure and are preferred over other data sources like pharmacy dispensing records [24][25][26]. We did not measure exposure to a therapeutic class or account for medication changes within the class (e.g., statins).…”