Initiation, Switching, and Cessation of Psoriasis Treatments Among Patients with Moderate to Severe Psoriasis in the United States

Armstrong, April W.; Koning, Jan; Rowse, Simon; Tan, Huaming; Mamolo, Carla; Kaur, Mandeep

doi:10.1007/s40261-017-0508-1

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…This study examined treatment patterns among psoriasis patients over a period longer than 12 months, enabling us to show that all of the examined outcomes became progressively worse over time, from 12 to 24 months. Our findings add to the growing literature indicating that adherence and persistence with the currently used biologics and apremilast may be problematic over the long term (17,18), particularly in patients with metabolic conditions (14)(15)(16).…”

Section: Discussionsupporting

confidence: 59%

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Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status

Feldman

Zhang

Martínez

et al. 2019

Journal of Dermatological Treatment

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Objectives: To compare treatment patterns and costs among psoriasis patients with and without metabolic conditions newly initiating a biologic or apremilast. Methods: Adult patients included had !1 prescription for secukinumab, adalimumab, ustekinumab, etanercept, or apremilast between 01/01/2015 and 08/31/2018 (date of first prescription was index date) and no index drug use in the 12-months pre-index, and continuous enrollment in the 12-month pre-index and 24-month post-index periods. Patients were divided into mutually exclusive treatment cohorts and stratified by their pre-index metabolic condition status. Treatment patterns (adherence, non-persistence, switching, discontinuation, use of combination therapy, and re-initiation) and healthcare costs were compared. Results: Overall, 7773 patients were included; 47.5-56.7% had a metabolic condition. Except for the apremilast group, patients with metabolic conditions had higher discontinuation (secukinumab: 50.6% vs. 43.7%; adalimumab Ã : 53.9% vs. 48.7%; ustekinumab Ã : 41.9% vs. 35.1%; etanercept: 42.8% vs. 41.2%; apremilast: 43.1% vs. 46.1%) and switching (secukinumab: 48.1% vs. 41.2%; adalimumab Ã : 47.8% vs. 41.9%; ustekinumab Ã : 34.5% vs. 25.3%; etanercept Ã : 53.6% vs. 51.5%; apremilast: 45.8% vs. 44.6%) than patients without (Ã p < .05). Patients with metabolic conditions incurred significantly higher costs. Conclusion: Many psoriasis patients initiating biologics or apremilast had metabolic conditions. These patients had higher discontinuation and switching, and significantly higher healthcare costs.

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Section: Discussionsupporting

confidence: 59%

“…Long-term real-world treatment patterns are not wellcharacterized in psoriasis, with the majority of US studies only considering the first 12 months after treatment initiation (17,18). In particular, comparative treatment patterns in patients with and without metabolic conditions (i.e.…”

Section: Introductionmentioning

confidence: 99%

Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status

Feldman

Zhang

Martínez

et al. 2019

Journal of Dermatological Treatment

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“…According to other studies, and emphasised in the current German S3 Guidelines for psoriasis and chronic spontaneous urticaria, biologicals should be used in treatment refractory, moderate to severe psoriasis and chronic spontaneous urticaria . Although many studies showed a cost‐effectiveness advantage, only a minority of patients are treated in accordance with these guidelines, and an undertreatment of moderate to severe psoriasis seems to be very common . Even though there is a positive trend in the usage of systemic therapies, this issue has to be addressed to improve psoriasis health care nationwide, with an emphasis on including rural areas, as proposed by the World Health Organisation (WHO) in their Global Psoriasis Report .…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Although many studies showed a cost-effectiveness advantage, only a minority of patients are treated in accordance with these guidelines, 2,[13][14][15][16][17] and an undertreatment of moderate to severe psoriasis seems to be very common. 18 Even though there is a positive trend in the usage of systemic therapies, 19 this issue has to be addressed to improve psoriasis health care nationwide, with an emphasis on including rural areas, as proposed by the World Health Organisation (WHO) in their Global Psoriasis Report. 16,19,20 In this context, the WHO also stresses the need for improvement of health service research and research on barriers hindering guideline-compliant treatment.…”

Section: Introductionmentioning

confidence: 99%

Guideline‐compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria

Schielein

Tizek

Rotter

et al. 2018

Acad Dermatol Venereol

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The role of clinical education and the importance of external and economic barriers in comparison with medical barriers have to be emphasised. Guideline-compliant use of biologicals has to be optimised. Further research is needed to ascertain not only a barrier pattern for Bavaria but also for wider settings. Actions based on this for psoriasis are needed to achieve the goal of the WHO Global Psoriasis Report to strengthen the role of patient-centred care and improve the quality of life of affected patients. Analogue, this applies also for urticaria.

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“…Combination therapy with topical steroids and topical vitamin A or D compounds is superior to either therapy alone [3]. However, topical therapies are commonly discontinued due to expense and inconvenience of continued application, especially in moderate to severe forms of psoriasis [5]. An alternative to topical therapies is oral, subcutaneous or intravenous immunomodulators and biologics.…”

Section: Introductionmentioning

confidence: 99%

Psoriasis and Fat-soluble Vitamins: A Review

Usedom¹,

Neidig²,

Allen³

2017

J Clin Exp Dermatol Res

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Fat-soluble vitamins exhibit numerous routes of immune modulation and specifically alter a variety of pathways in psoriasis pathology. Psoriasis, a chronic immune-mediated disease, often requires a combination of topical, oral, and occasionally, subcutaneous or intravenous therapies making disease management complex. With the complexity of treatment, patient adherence is reduced. Vitamin supplementation as an adjunctive treatment would minimize potential adverse effects from systemic medication, increase patient adherence and decrease overall cost. While vitamin A and D are effective topically, oral supplementation is not currently a mainstay of therapy although data exists to support such supplementation. Data on vitamin E and K implicate the significant role each has in the alteration of the inflammatory cascade responsible for psoriasis. Research showing fat-soluble vitamin deficiency in psoriasis exists and presents greater evidence for oral vitamin treatment in addition to first-line therapies. This review presents the mechanism of action in psoriasis of each fat-soluble vitamin and the data on the efficacy of oral fat-soluble vitamin supplementation in psoriasis and systemic inflammation. We also present fat-soluble vitamin deficiency data shown in psoriasis patients. With the evidence of their targeted mechanism of action, efficacy data with oral supplementation, and evidence of deficiency in patients, oral fat-soluble vitamins should be considered as an adjunct to therapy in psoriasis patients.

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Initiation, Switching, and Cessation of Psoriasis Treatments Among Patients with Moderate to Severe Psoriasis in the United States

Abstract: Based on health claims data, undertreatment of moderate to severe psoriasis appeared to be common.

Cited by 17 publications

References 24 publications

Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status

Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status

Guideline‐compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria

Psoriasis and Fat-soluble Vitamins: A Review

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