Apremilast Prolongs the Time to First Biologic Therapy in Japanese Patients with Psoriasis

Abstract

Introduction Biologic agents are used in patients with severe psoriasis who have not adequately responded to existing conventional systemic therapies. However, only a limited number of medical institutions in Japan are approved to use them, and their relatively high cost represents a substantial burden to patients. Apremilast is an oral phosphodiesterase-4 inhibitor approved in Japan for the treatment of psoriasis vulgaris in adult patients with an inadequate response to topical therapies and psoriatic arthritis in adult patients with active disease. To date, a large-scale real-world study of treatment patterns and costs associated with apremilast in Japan has not been conducted. The objective of this study was to assess whether apremilast can prolong time to first biologic therapy use and decrease total medical cost. Methods Using the Medical Data Vision hospital-based claims database, 506 psoriasis patients were propensity score matched and analyzed (apremilast: n = 253; non-apremilast: n = 253). Results The incidence rate of first biologic therapy use per 1000 patient-years was significantly lower in the apremilast group than in the non-apremilast group (30.3 vs. 107.6; P < 0.001), and the total medical costs per month were significantly lower in the apremilast group than in the non-apremilast group (76,594 yen/month vs. 102,411 yen/month, P < 0.001). In a sensitivity analysis of a propensity-score-matched subset of eligible patients prescribed biologics during the follow-up period (apremilast: n = 14; non-apremilast: n = 14), the incidence of first biologic therapy use was 2,797.6 per 1000 patient-years (95% CI: 1,656.9, 4,723.6) in the non-apremilast group and 856.1 per 1000 patient-years (95% CI: 507.0, 1,445.5) in the apremilast group. Conclusion These results suggest that apremilast prolongs the time to first biologic therapy use in patients with psoriasis, thereby reducing the total medical cost and decreasing the economic burden on patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00659-w.

Apremilast in the Treatment of Plaque Psoriasis: Differential Use in Psoriasis

“…Apremilast has the added utility of delaying the use of biological agents, some of which can be more costly and associated with more adverse effects. 21 Further, cost-efficacy analyses of systemic anti-psoriatic agents favor apremilast to most other commonly-used biological agents. 22 …”

Treatment patterns, healthcare resource utilization, and costs in patients with moderate‐to‐severe psoriasis treated with systemic therapy in Japan: A retrospective claims database study

“…The persistence rate at 12 months was generally high among patients receiving biologics (≥70% of patients receiving ustekinumab, brodalumab, and guselkumab), but low among patients receiving oral systemic treatments (<50%; Figure 2). Specifically, persistence rates [95% CI] were 44% [41,47] for apremilast, 19% [15,23] for cyclosporin, and 20% [16,25] for etretinate. The time on treatment across all oral systemic treatments was <8 months (median [range]: apremilast, 7.2 [0.3, 12.0] months; cyclosporin, 2.1 [0.1, 12.0] months; and etretinate, 3.1 [0.1, 12.0] months), whereas, for most biologics, the median time on treatment could not be estimated as patients were censored at 12 months (Figure 2).…”

“…21 Additionally, HCRU associated with apremilast use in Japan has also been documented. 23 However, data on the direct impact of PsO on medical costs are limited. According to a study that used claims data from the Japan Medical Data Center (JMDC) from…”

“…For example, a recent study by Okubo et al compared HCRU between Japanese patients with GPP and plaque PsO and healthy controls, demonstrating greater HCRU, such as outpatient visits and hospitalization duration in patients with GPP and plaque PsO 21 . Additionally, HCRU associated with apremilast use in Japan has also been documented 23 . However, data on the direct impact of PsO on medical costs are limited.…”

“… 21 Additionally, HCRU associated with apremilast use in Japan has also been documented. 23 However, data on the direct impact of PsO on medical costs are limited. According to a study that used claims data from the Japan Medical Data Center (JMDC) from 2009 to 2016, the annual per patient total medical cost incurred by an average patient with PsO using biologics ranged between Japanese Yen (JPY) 2.2 and 3.4 million (approximately United States Dollar [USD] 17 000 to 27 000), demonstrating a high economic burden.…”