Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

Abstract

Background Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population. Objective We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab. Methods We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting. Results We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic. Limitations Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data. Conclusion Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.

Effectiveness End Points in Real-World Studies on Biological Therapies in Psoriasis: Systematic Review with Focus on Drug Survival

“…The percentage of patients who discontinued biological therapies within the end of the follow-up period was reported in 90% of retrospective administrative databases/claims [28, 35, 36, 40-45] and in about 60% of other study designs. Compliance with biological therapies was rarely considered in these effectiveness studies [15, 43, 45, 53]. …”

Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

“…Stwierdzono też, że u pacjentów, którzy wcześniej nie odpowiedzieli na leczenie, terapia kolejnym lekiem biologicznym będzie krótsza niż u pacjentów niestosujących wcześniej leczenia biologicznego. Zauważono, że zjawisko to jest bardziej nasilone, gdy pierwszym stosowanym lekiem jest inhibitor TNF-α, a kolejnym ustekinumab [21,25].…”

“…Tak rozbieżne wyniki badań mogą świadczyć o istnieniu innych, niepoznanych jeszcze czynników, które mają wpływ na skuteczność leczenia. Wśród predyktorów odpowiedzi na leczenie biologiczne wymienia się płeć pacjenta [21,24,25,29] oraz masę ciała [26]. Wielu A growing body of studies demonstrate that there are factors making biologic drugs ineffective during prolonged use, and that certain groups of patents show a poorer response to treatment.…”

“…It has also been shown that in biologic therapy non-responders treatment with another biologic drug is shorter than in patients previously untreated with biologic drugs. The correlation has been noted to be more pronounced if the first drug used is a TNF-α inhibitor, and the next drug is ustekinumab [21,25].…”

“…Przyczyny tego zjawiska nie są dobrze poznane, dlatego ważne jest, by prowadzić badania mające na celu zidentyfikowanie czynników mogących predysponować do gorszej odpowiedzi na leczenie. Wiedza ta umożliwiłaby to biologic therapy have been mentioned to include patient gender [21,24,25,29] and body weight [26]. Many authors claim that a reduced duration of drug action may be attributed to immune factors such as the development of antibodies against the drug [3,21,[30][31][32][33][34][35].…”