Treatment patterns in psoriatic arthritis patients newly initiated on oral nonbiologic or biologic disease-modifying antirheumatic drugs

Abstract

IntroductionThis study aimed to describe treatment changes (discontinuation, switching, and therapy add-on) following the initiation of biologic or nonbiologic oral disease-modifying antirheumatic drugs (DMARDs) in psoriatic arthritis (PsA) patients.MethodsAdult patients with ≥2 PsA diagnoses from physician office visits, initiated on a biologic or nonbiologic oral DMARD, were selected from the Truven Health Analytics MarketScan® Research Database (2005 to 2009). Patients were required to have continuous insurance coverage ≥6 months prior to and ≥12 months post index date (first prescription fill date). Treatment discontinuation, treatment switch, and therapy add-on were captured over the 1 year period following the index date. Treatment changes were described separately for patients initiated on nonbiologic and biologic DMARDs.ResultsA total of 1,698 and 3,263 patients were initiated on an oral nonbiologic DMARD and biologic DMARD respectively. For patients initiated on nonbiologic DMARDs, 69% had ≥1 therapy change over the 12 month study period (median time 85 days). Among patients who had a therapy change, 83% discontinued, 29% switched therapy (64% switched to a biologic DMARD), and 25% had a therapy add-on (76% added-on with a biologic DMARD). For patients initiated on a biologic DMARD, 46% had ≥1 therapy change (median time 110 days). Among patients who had a therapy change, 100% discontinued, 25% switched therapy (92% switched to another biologic DMARD), and 7% had a therapy add-on with a nonbiologic DMARD.ConclusionThis study suggests that PsA patients newly initiated on a nonbiologic/biologic DMARD do not remain on the index treatment for a long period of time. A better understanding of factors related to these early treatment changes in PsA patients is needed.

Treatment patterns and sequencing in patients with rheumatic diseases: a retrospective claims data analysis

“…Adalimumab and etanercept are well-established TNFi and generally reported as the most common treatments initiated among patients starting advanced treatments [14][15][16][17] . Switching rates found in the current study are also generally consistent with those reported in the literature 15,18 . In a recent study by Wu et al, assessing treatment patterns in PsA patients treated with bDMARDs (TNFi and non-TNFi) versus apremilast, authors reported a 33.3% switching rate at 2 years after treatment initiation in the bDMARDs cohort 15 the switching rate among PsA patients was 32.3% at 2 years in the current study.…”

Persistence and adherence of biologics in US patients with psoriatic arthritis: analyses from a claims database

“…Other US claims-based studies of patients with PsA who initiated sc. biologics have used shorter treatment gaps (>45 or >60 days) to define discontinuation [27,[35][36][37][38][39]. Although not every study examined individual biologics or used the same treatment gaps, complicating cross-study comparisons, the overall rate of discontinuation in our study using a >45-day gap (56.5%) was comparable to ranges of rates of nonpersistence (adalimumab, range: 41-63%; etanercept, 42-61%; biologics, 46-51%) observed in these studies.…”

Treatment Patterns Among Patients with Psoriatic Arthritis Treated with a Biologic in the United States: Descriptive Analyses from an Administrative Claims Database

“…4,[30][31][32][33] However, real-world studies examining biologic therapy use in U.S. patients with PsA are limited, especially those involving treatment modifications. Recently published studies have examined biologic therapy treatment patterns, 32,[34][35][36][37][38] but updated estimates of treatment adherence and persistence that reflect new therapies approved for PsA, and studies of dose escalation of biologic therapy and adjunctive medications, are still needed. The objective of this study was to describe treatment patterns and therapy modifications in U.S. patients who newly initiated an approved FDA biologic therapy for PsA at the time of the study (either a TNFi or an anti-IL-12/23 inhibitor).…”