Modeling the optimal sequence of biologic therapies in plaque psoriasis in Spain

Egeberg, Alexander; Danø, Anne Møller; Pedersen, Mikkel H; Sohrt, Anne; Borg, Emma; Notario, J.

doi:10.1080/13696998.2021.1970953

Cited by 6 publications

(12 citation statements)

References 15 publications

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“…Our results highlight that recommending clinicians prescribe more efficacious treatments earlier in the course of therapy provides a greater opportunity to minimize treatment failures and maximize patient outcomes. These findings are supported by other literature, whereby in a single disease area (PsO), modelled treatment sequences starting with more efficacious therapies may have greater health outcomes [ 33 , 34 ]; our contribution has been to show that current prescribing patterns, often limited by fixed budgets, have potential to improve patient outcomes further. PsO has the largest difference in efficacy between treatment sequences; it is therefore especially important to assess where a country’s prescribing policies and behaviours sit within the wide range of possible outcomes.…”

Section: Discussionsupporting

confidence: 79%

“…A number of studies have attempted to explore or narrow down which sequences of treatments may be more optimal for patient outcomes at a single-disease level, either through analysis of real-world observation data [ 31 , 32 ], treatment sequencing models [ 33 , 34 ], or network meta-analyses (NMAs) [ 35 ]. However, to date an approach that combines treatment sequence efficacy with local current prescribing practices, and presents the relative impact of cost and benefit associated with adopting the most efficacious sequences across these diseases, has yet to be explored.…”

Section: Introductionmentioning

confidence: 99%

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Modelling Treatment Sequences in Immunology: Optimizing Patient Outcomes

Hart,

Hassan,

Alulis

et al. 2024

Adv Ther

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Introduction For some immune-mediated disorders, despite the range of therapies available there is limited evidence on which treatment sequences are best for patients and healthcare systems. We investigated how their selection can impact outcomes in an Italian setting. Methods A 3-year state-transition treatment-sequencing model calculated potential effectiveness improvements and budget reallocation considerations associated with implementing optimal sequences in ankylosing spondylitis (AS), Crohn’s disease (CD), non-radiographic axial spondyloarthritis (NR-AxSpA), plaque psoriasis (PsO), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ulcerative colitis (UC). Sequences included three biological or disease-modifying treatments, followed by best supportive care. Disease-specific response measures were selected on the basis of clinical relevance, data availability, and data quality. Efficacy was differentiated between biologic-naïve and experienced populations, where possible, using published network meta-analyses and real-world data. All possible treatment sequences, based on reimbursement as of December 2022 in Italy (analyses’ base country), were simulated. Results Sequences with the best outcomes consistently employed the most efficacious therapies earlier in the treatment pathway. Improvements to prescribing practice are possible in all diseases; however, most notable was UC, where the per-patient 3-year average treatment failure was 37.3% higher than optimal. The results focused on the three most crowded and prevalent immunological sub-condition diseases in dermatology, rheumatology, and gastroenterology: PsO, RA, and UC, respectively. By prescribing from within the top 20% of the most efficacious sequences, the model found a 15.1% reduction in treatment failures, with a 1.59% increase in drug costs. Conclusions Prescribing more efficacious treatments earlier provides a greater opportunity to improve patient outcomes and minimizes treatment failures. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02766-w.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Modelling Treatment Sequences in Immunology: Optimizing Patient Outcomes

Hart,

Hassan,

Alulis

et al. 2024

Adv Ther

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“…In addition, we did not analyse the costs in the different lines of treatment. Edgeberg et al studied the impact of the place in the treatment sequence on the cost and cost-effectiveness of different biologics for patients with moderate/severe plaque psoriasis 41. They concluded that the most cost-effective treatment sequence was brodalumab-risankizumab-guselkumab-ixekizumab, with a cost per responder of €139 281 during the first 5 years of treatment.…”

Section: Discussionmentioning

confidence: 99%

Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors

et al. 2023

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ObjectivesInterleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was to describe the effectiveness and safety of anti-IL-17 agents in moderate/severe plaque psoriasis in clinical practice. We also analysed anti-IL-17 therapies’ survival, dose adjustment, and clinical patients’ factors associated with their effectiveness and safety.MethodsA retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate/severe psoriasis treated with anti-IL-17 agents. The effectiveness was evaluated with Psoriasis Area and Severity Index (PASI) score and safety through the adverse drug reactions (ADRs) collected.Results38 patients were studied (median age=47.4 years, 71.0% male). The mean number of biological therapies that patients received was 2.6, and anti-IL-17 therapy was the first biological therapy for 36.8% of patients. The median years in treatment were 2.5 (95% CI 1.95 to 2.98) for secukinumab, 1.2 (95% CI 0.36 to 1.47) for ixekizumab, and 0.7 (IQR 0.71) for brodalumab. The median PASI score after 6 months of treatment was 0 (IQR 0) and 85.3% of patients achieved a PASI of 90 (84.0% with secukinumab, 87.5% with ixekizumab, and 100% with brodalumab). Dose adjustment was associated with the line of treatment (p=0.034 for naïve patients), age (p=0.044 for younger patients), and concomitant pathologies (p=0.015 without more diseases).24 patients suffered from ADRs, mainly infections of the upper respiratory tract, and there were no statistically significant differences between the three therapies.ConclusionsAnti-IL-17 agents constitute an effective treatment for patients with moderate/severe plaque psoriasis and for longer. Dose reductions were associated with fewer lines of treatment, younger patients and absence of concomitant pathologies. ADR were minor and similar among the anti-IL-17.

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“…Given the cost of biologic drugs, it is important to consider the cost-effectiveness of different treatment options. 11 , 12 , 17 This is an important consideration, as the choice of treatment sequence can have a significant impact on the overall cost of treatment, as well as the likelihood of achieving good disease control. 17 …”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 , 17 This is an important consideration, as the choice of treatment sequence can have a significant impact on the overall cost of treatment, as well as the likelihood of achieving good disease control. 17 …”

Section: Introductionmentioning

confidence: 99%

The Cost-Effectiveness of Anti-IL17 Biologic Therapies for Moderate-to-Severe Plaque Psoriasis Treatment in Italy and Germany: A Sequential Treatment Analysis

Nyholm¹,

Danø²,

Schnack³

et al. 2023

CEOR

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Objective The objective of this study was to optimise the cost-effectiveness of different anti-IL17 treatment sequences used in the treatment of moderate-to-severe plaque psoriasis in Italy and Germany over a five-year time horizon. Methods We adjusted a previously published treatment sequence model for biologic drugs used in psoriasis treatment to an Italian and German setting, respectively. The model included all anti-IL17 biologics currently available in the treatment of moderate-to-severe plaque psoriasis in the markets of scope (secukinumab, ixekizumab, brodalumab and bimekizumab). Real-world discontinuation rates were used to model switches between the four anti-IL17 biologics included in the study. The treatment costs were based on label dosing recommendations for each drug, including induction and maintenance therapy, and the manufacturer prices of each drug in Italy and Germany, respectively. We used long-term Psoriasis Area and Severity Index 100 (PASI100) measures to inform the model on the efficacy for each treatment. The cost-effectiveness in the analysis was evaluated based on the cost per PASI100-responder. Results We found that the most cost-effective treatment sequence was achieved by using brodalumab as first-line treatment, bimekizumab as second-line treatment, ixekizumab as third-line treatment and secukinumab as fourth-line treatment in both Italy and Germany, which resulted in a total cost per responder of €128,200 and €138,212, respectively, over a five-year period. Several scenario analyses were also conducted and ensured that the results were robust to changes in key input parameters. Conclusion Our study showed that using brodalumab as a first-line therapy to treat moderate-to-severe psoriasis in both Italy and Germany leads to the most cost-effective treatment sequence, when compared to all possible combinations of anti-IL17s over a five-year time horizon. In addition, we found that treatment discontinuation and switching are important factors when assessing the cost-effectiveness of biologic therapies.

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Modeling the optimal sequence of biologic therapies in plaque psoriasis in Spain

Cited by 6 publications

References 15 publications

Modelling Treatment Sequences in Immunology: Optimizing Patient Outcomes

Modelling Treatment Sequences in Immunology: Optimizing Patient Outcomes

Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors

The Cost-Effectiveness of Anti-IL17 Biologic Therapies for Moderate-to-Severe Plaque Psoriasis Treatment in Italy and Germany: A Sequential Treatment Analysis

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