<p>Comparison of Real-World Treatment Patterns Among Psoriasis Patients Treated with Ixekizumab or Adalimumab</p>

Abstract

Background: There is lack of real-world treatment pattern comparison data between ixekizumab and adalimumab which are approved for the treatment of moderate-to-severe plaque psoriasis. Objective: To compare real-world treatment patterns among psoriasis patients initiating ixekizumab or adalimumab in the United States. Methods: Psoriasis patients with ≥1 claim for ixekizumab or adalimumab between March 1, 2016, and May 31, 2018, were identified (index date = date of first ixekizumab or adalimumab claim) from the IBM Watson Health MarketScan ® databases. Patients were required to be continuously enrolled for ≥12 months before the index date and followed for a minimum of 6 months until inpatient death, enrollment end, or study end, whichever occurred first. Treatment persistence, adherence, discontinuation, restart, and switching were analyzed. Inverse probability of treatment weighting and multivariable regression modeling were employed to address cohort imbalances and estimate the adjusted risk of non-persistence, discontinuation, and switching, and the odds of adherence. Results: A total of 646 ixekizumab and 3668 adalimumab users were included and followed for a mean of 14.0 and 16.5 months, respectively. Compared to adalimumab, ixekizumab was associated with 19% lower risk of non-persistence (hazard ratio [HR]=0.81, 95% confidence interval [CI]: 0.69-0.95), 26% lower risk of discontinuation (HR=0.74, 95% CI: 0.62-0.88), and 28% lower risk of switching (HR=0.72, 95% CI: 0.57-0.91). Ixekizumab users had higher odds of medication possession ratio ≥80% (odds ratio [OR]=1.36, 95% CI: 1.10-1.69) but similar odds by proportion of days covered ≥80% (OR=1.22, 95% CI: 0.98-1.53). Conclusion: Psoriasis patients treated with ixekizumab demonstrated longer persistency, higher adherence and were less likely to discontinue or switch treatment compared to adalimumab users. However, while patients achieving highly adherent threshold significantly differed by MPR ≥80%, it did not by PDC ≥80%; hence, further analysis using fixed-length follow-up is required.

Drug survival of ixekizumab, TNF inhibitors, and other IL‐17 inhibitors in real‐world patients with psoriasis: The Corrona Psoriasis Registry

“…As expected, drug survival was worse among biologic‐experienced patients compared with biologic‐naïve patients, yet in both cohorts, ixekizumab had better survival than TNFi and non‐ixekizumab IL‐17i. Our 12‐month drug‐survival rates among biologic‐experienced patients of 65% for ixekizumab vs 34% for TNFi, and 54% for non‐ixekizumab IL‐17i initiators, are comparable to those recently reported for adalimumab (12 months survival: 55% for ixekizumab vs 47% for adalimumab) 3 and secukinumab (12 months survival: 57% for ixekizumab vs 50% for secukinumab) 25 . The higher drug survival observed among ixekizumab users is consistent despite most users being biologic‐experienced, a subgroup of patients who have been shown to have lower drug survival than biologic‐naïve users 38, 39 .…”

“…Differences between our estimates of drug survival and those in this study are most likely due to differences in baseline characteristics, as well as natural trends over time, since the meta-analysis encompassed studies published as early as 2010. 55% for ixekizumab vs 47% for adalimumab) 3 and secukinumab (12 months survival: 57% for ixekizumab vs 50% for secukinumab). 25 The higher drug survival observed among ixekizumab users is consistent despite most users being biologic-experienced, a subgroup of patients who have been shown to have lower drug survival than biologic-naïve users.…”

“…Additionally, regression results were robust to sensitivity analyses using time-dependent coefficients for covariates where the proportional hazards assumption may not have been met: the adjusted hazard ratio (Model 2) for the ixekizumab group in comparison to the TNFi group was 0.36 (95% CI, 0.27-0.47, P < .001), and for the ixekizumab group in comparison to the non-ixekizumab IL-17i group was 0.69 (95% CI, 0.55-0.87, P < .002). Drug survival of TNFi such as adalimumab 3 and etanercept 17,[32][33][34][35][36][37] and a newer non-ixekizumab IL-17i such as secukinumab 25 have been reported. Comparison of the results from this study and other prior studies is difficult as drug survival rates differed and decreased over time among biologic therapies.…”

“…Psoriasis negatively impacts quality of life and work productivity, [1][2][3] and is associated with several other comorbidities, including cardiovascular disease, Crohn's disease, depression, and anxiety. 4 setting is a much more complex environment, where the actual drug utilization can be biased by many factors depending on the treatment strategy adopted by the clinician, the drug, and the patient in a specific health care system.…”

“…Currently, there are few studies comparing the drug survival for ixekizumab to that of other biologic therapies in real‐world patients with PsO. Two recent claims‐based studies of US patients demonstrated greater drug survival for ixekizumab vs adalimumab 3 and secukinumab patients 25 . In addition to the demonstrated favorable ixekizumab drug survival compared with these specific treatments (adalimumab and secukinumab), there is a need to understand whether similar findings are observed when ixekizumab users are compared with other biologics‐users, overall, among PsO patients.…”