Treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriatic arthritis: results from a US claims analysis

Wu, Jashin J.; Pelletier, Corey; Ung, Brian; Tian, Marc

doi:10.1080/03007995.2019.1668204

Cited by 12 publications

(17 citation statements)

References 21 publications

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“…Although we observed better persistence and adherence among patients with PsA who initiated the IL-12/23i compared to patients who initiated TNFis and tsDMARDs, a little more than half of patients still discontinued their treatment within 1 year. 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 ].…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2021

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Introduction: This study compared treatment persistence and adherence among psoriatic arthritis (PsA) patients in the US who initiated an interleukin-12/23 inhibitor (IL-12/23i) versus those who initiated tumor necrosis factor inhibitors (TNFis), targeted synthetic diseasemodifying antirheumatic drugs (tsDMARDs), or interleukin-17 inhibitors (IL-17is). Methods: Adults diagnosed with PsA with C 1 claim for a targeted immune modulator were selected from the IBM MarketScan Ò Commercial and Medicare Supplemental databases (October 1, 2013-October 31, 2018. The date of

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Section: Discussionsupporting

confidence: 89%

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

et al. 2021

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“…Discontinuation was defined as at least a 60-day continuous gap after fulfillment of days' supply in the previous adalimumab claim. A continuous gap of at least 60 days was chosen on the basis of a review of previous literature evaluating biologic treatment patterns in psoriatic arthritis [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Adherence and Persistence Differences Between Adalimumab Citrate-Free and Citrate Formulations for Patients with Immune-Mediated Diseases in the United States

et al. 2020

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Introduction: Our aim was to evaluate patient adherence and persistence with citrate-free adalimumab (ADA-CF), introduced in 2018 to reduce injection-site pain, compared with citrate-containing adalimumab (ADA-C). Methods: This was a retrospective cohort study using a US claims database (IBM Ò MarketScan Ò Commercial and Medicare Supplemental Claims Database) from February 2018 to January 2020. Patients at least 18 years of age who were naïve to adalimumab 6 months before the index date (date of first adalimumab claim) and with at least 12 months of continuous medical and pharmacy coverage were eligible for the study. Adherence was assessed by determining the proportion of days covered (PDC) and the percentage of patients with PDC C 80% during the 12-month follow-up period. Persistence was evaluated by measuring the rate of discontinuation and days to discontinuation (i.e., time on treatment) from the index date over the 12-month follow-up period. Continuous adherence outcomes (PDC) were evaluated using linear regression models. Binary adherence outcomes (PDC C 80%) were assessed using logistic regression models. Kaplan-Meier analysis and Cox proportional hazards models were used to assess persistence outcomes. Results: There were 2195 and 1005 patients in the ADA-CF and ADA-C cohorts, respectively, with most using adalimumab for rheumatoid arthritis (ADA-CF 29.7%, ADA-C 27.2%) and psoriasis (ADA-CF 24.5%, ADA-C 31.9%). Significantly greater adherence was achieved with ADA-CF compared with ADA-C (mean PDC [standard deviation] 0.68 [0.30] vs 0.61 [0.32], P \ 0.0001). A significantly greater percentage of patients receiving ADA-CF (47.2%) vs ADA-C (39.6%) had PDC C 80% (P \ 0.0001). The discontinuation rate was significantly lower for the ADA-CF cohort (46.4%) compared with ADA-C (55.9%, P \ 0.0001), resulting in a 27% lower likelihood of discontinuation during the 12-month follow-up period (hazard ratio 0.73; 95% confidence interval 0.66, 0.82; P \ 0.0001) and longer time on treatment (260 vs 232 days, P \ 0.0001). Conclusion: Adherence and persistence are significantly improved with ADA-CF compared with ADA-C.

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“…Similarly, greater mean physician encounters were observed for patients indexing to oral immunotherapy in the joint cohort, showed that switching rates were similar among patients initiating oral apremilast versus biologics in those with PSO or PsA. 26,27 Our finding of greater switching within skin and joint and skin cohorts indicates that oral immunotherapy in general might not be as effective and/or tolerated as injectable immunotherapies in the treatment of these chronic conditions because switching medications is considered a potential proxy for lack of treatment effect. 43 Switching was also marginally greater for the joint cohort, although lacked statistical significance.…”

Section: ■■ Discussionmentioning

confidence: 86%

“…Similar results were mirrored in studies comparing apremilast to biologics in patients with PsA and PSO. 26,27 The average 12-month total health care cost for patients with PsA on apremilast was approximately $28,000 versus $37,000 for those on biologics and approximately $21,000 versus $41,000 for patients with PSO. 26,27 Patients who respond well to oral medications may see sufficient treatment effect while incurring considerably lower costs.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…24,25 Although the efficacy of tofacitinib and apremilast has been demonstrated, data on effectiveness in real-world settings are minimal. [26][27][28] With easy administration and adherence/persistence akin to biologic immunotherapies, 26,27,29 oral therapies are receiving greater acceptance in clinical practice. However, there is a scarcity of evidence on how effectiveness of oral agents compares with injectable immunotherapies on various health care utilization and cost outcomes across different chronic inflammatory diseases.…”

Section: What This Study Addsmentioning

confidence: 99%

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Comparing Medical Utilization and Cost Outcomes in Oral Versus Injectable Immunotherapy Users with Chronic Inflammatory Joint and Skin Diseases

Bhattacharya

Herren

Poonawalla

et al. 2020

JMCP

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BACKGROUND: Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis (PSO) are immune-mediated systemic, chronic inflammatory conditions. Moderate to severe disease is treated with conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, or leflunomide. If a patient does not respond to these firstline treatments, then tumor necrosis factor inhibitor (TNFi) or non-TNFi immunotherapy agents are administered via infusion, injection, or taken orally. Although the effectiveness of established infusion, injection, and newer oral therapies are known, the relative effectiveness among the routes of administration is not well understood.OBJECTIVE: To compare drug use, health care resource utilization, and costs among patients who are treatment-naive to oral immunotherapy and injectable biologic immunotherapy.METHODS: This retrospective observational study used claims data from a large U.S. health plan to identify new users of oral and injectable immunotherapy, diagnosed with a joint (RA or PsA), skin (PSO), or joint and skin condition from July 1, 2014, to June 30, 2017. The index date was the first claim for an oral or injectable medication. Medicaid, Medicare Advantage, and commercial plan patients aged 19-89 years with continuous enrollment 6 months before and 12 months after the index date were included in the study. Outcomes were adjusted using propensity score by inverse probability of treatment weighting. Treatment discontinuation, switching, health care resource utilization, and costs were measured during the post-index period. RESULTS: Oral versus injectable users with joint (n = 458 vs. 3,875), skin (n = 265 vs. 951), or joint and skin (n = 171 vs. 805) conditions were identified. For drug utilization outcomes, no differences in discontinuation rates were observed between oral and injectable groups for any of the cohorts. However, those in skin and joint and skin cohorts had higher rates of switching to other immunotherapies in patients initiated on orals compared with injectables. Health care resource utilization outcomes were mixed. While mean outpatient and physician office visits were significantly higher in oral compared with injectable groups across all 3 cohorts, no differences were observed for inpatient stays. Total costs (medical plus pharmacy) were lower for oral groups across all 3 cohorts. Pharmacy costs were lower for oral groups, but medical costs were higher for oral groups across all 3 cohorts. CONCLUSIONS: This is the first population-level study at a route-ofadministration level, which compared switching, health care resource utilization, and costs across several conditions. Switching drugs was more likely in the oral group, which may indicate lower effectiveness or tolerability of oral immunotherapies relative to injectables. Health care resource utilization was higher in the oral group, but total costs were lower, which was likely driven by the lower costs of oral drugs.

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Treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriatic arthritis: results from a US claims analysis

Cited by 12 publications

References 21 publications

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

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

Evaluation of Adherence and Persistence Differences Between Adalimumab Citrate-Free and Citrate Formulations for Patients with Immune-Mediated Diseases in the United States

Comparing Medical Utilization and Cost Outcomes in Oral Versus Injectable Immunotherapy Users with Chronic Inflammatory Joint and Skin Diseases

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