Real-world 2-year treatment patterns among patients with psoriatic arthritis treated with injectable biologic therapies

Abstract

Objectives: To assess long-term (2-year) biologic treatment patterns of psoriatic arthritis (PsA) patients who initiated adalimumab, certolizumab pegol, etanercept, golimumab, or ustekinumab. Methods: Adult patients with !1 pharmacy or medical claim for injectable PsA biologics (index date) were identified from the Optum's Clinformatics Data Mart (1 January 2013-31 December 2016). Adherence, persistence, post-discontinuation treatment patterns, and addition of adjunctive medications were evaluated by index biologic. Results: Of 996 patients included (mean [SD] age: 51.5 [12.6] years; female: 49.4%), the most common index biologics initiated were adalimumab (47.9%) and etanercept (34.5%). The mean [SD] proportion of days covered was 0.48 [0.32] for the index biologics. During the 24-month follow-up period, 19.7% of patients persisted on their index biologic; ustekinumab had the highest persistence rate (27.2%), followed by adalimumab (22.0%), golimumab (18.4%), certolizumab pegol (15.6%), and etanercept (15.4%). Of the 800 patients (80.3%) who discontinued their index biologic therapy, 35.0% restarted, 40.1% switched to another biologic, and 31.8% did neither during the follow-up period. The most common biologics patients switched to were adalimumab (31.2%) and ustekinumab (18.7%). Among patients who persisted with their index biologic for !90 days (n ¼ 753), !1 adjunctive medication was added for 50.1% of patients. The most common adjunctive medications included corticosteroids (28.0% of patients), opioids (17.0%), nonsteroidal anti-inflammatory drugs (NSAIDs) (13.8%), and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) (7.3%). Conclusions: In this real-world study of use of biologic PsA therapies, 24-month persistence was low (19.7%), and treatment was frequently supplemented with adjunctive medications.

Treatment Persistence and Adherence Among Patients With Psoriatic Arthritis Who Initiated Targeted Immune Modulators in the US: A Retrospective Cohort Study

“…In this real-world study of commercially insured patients with PsA, those who initiated an IL-12/ 23i had significantly longer treatment persistence, a lower discontinuation rate, and higher treatment adherence compared to patients who initiated either a TNFi or a tsDMARD during 1 year of follow-up. As expected, the magnitude of difference between medication classes varied according to the definitions of allowable gaps, but the pattern of higher persistence and adherence with IL12/23i than TNFi and tsDMARD was observed throughout both the main analysis and the sensitivity analyses [8,9]. Persistence and adherence were similar between IL-12/23 and IL-17i with most outcomes, but a minority of persistence outcomes favored IL-12/ 23i.…”

“…These findings are similar to other studies conducted over the past several years, in which discontinuation rates within 1 year of treatment initiation ranged from 33% to nearly 70% among PsA patients treated with biologics or other advanced therapies [ 5 , 6 , 8 , 10 , 11 ]. Furthermore, in a study of patients with PsA treated with injectable biologic drugs (adalimumab, certolizumab pegol, etanercept, golimumab, or ustekinumab), the overall discontinuation rate within 2 years of initiation was approximately 80% [ 9 ].…”

Real-World Treatment Persistence with Biologic Disease-Modifying Antirheumatic Drugs Among German Patients with Psoriatic Arthritis—A Retrospective Database Study

“…Although the current study did not evaluate persistence beyond 12 months, previous research has shown that persistence rates decrease with time. Walsh et al reported a decrease in persistence rate from 44.5% after 12 months [25] to 19.7% after 24 months [27] of follow-up. A change in persistence rate after an even longer period of time was reported by Jacob et al [15] (from 71.4% after 12 months to 33.2% after 60 months of follow-up).…”

Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 2 trial

“…8 9 Although biological agents are effective in treating PsA, 10 approximately 25%-40% of patients do not achieve at least 20% improvement in American College of Rheumatology score (ACR20), and clinical REM and minimal disease activity (MDA) are often short-lived. [11][12][13][14][15][16][17][18][19] Lack of efficacy frequently leads to treatment switching or discontinuation, which may negatively affect patients' clinical outcomes and increase treatment costs, [20][21][22][23][24] revealing a need for well-tolerated treatments with sustained efficacy.…”