Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use

Abstract

Psoriasis is a common chronic inflammatory disorder, primarily of the skin. Despite an aging population, knowledge of the epidemiology of psoriasis and its treatments among the elderly is limited. We examined the prevalence of psoriasis and its treatments, with a focus on biologics and identification of factors associated with biologic use, using a nationally representative sample of Medicare beneficiaries in 2011. Based on several psoriasis identification algorithms, the claims-based prevalence for psoriasis in the United States ranged from 0.51% to 1.23%. Treatments employed for moderate to severe psoriasis (phototherapy, oral systemic, or biologic therapies) were received by 27.3% of the total psoriasis sample, of whom 37.2% used biologics. Patients without Medicare Part D low-income subsidies had 70% lower odds of having received biologics than those with low-income subsidies (odds ratio 0.30; 95% confidence interval, 0.19– 0.46). Similarly, the odds of having received biologics was 69% lower among black patients than white patients (0.31; 0.16–0.60). This analysis identified potential financial and racial barriers to receipt of biologic therapies and underscores the need for additional studies to further define the epidemiology and treatment of psoriasis among the elderly.

Burden of chronic urticaria relative to psoriasis in five European countries

“…Even if this might be due to variation in the NHWS sampling method, it reflects the difference of prevalence between these diseases 4, 19. Self‐assessment of severity in PsO based on a validated, accepted method reflected a higher proportion of mild PsO patients compared to moderate/severe, but this is consistent with real‐world data 20. Other possible reason for this might be, as NHWS is a 30‐min online survey, PsO patients with high disease severity might be less able to participate in the survey.…”

“…The prevalence of PsO ranges between 1.5% and 5% in most developed countries 19. Among PsO patients, 71% of the PsO patients have mild PsO and 27% of PsO patients have moderate–severe PsO, remaining 2% could not be catagorized 20. Reduction in the HRQoL due to PsO is comparable with other chronic diseases such as depression, myocardial infarction, hypertension and even some cancers 21.…”

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

“…6–9 Little is known about treatment patterns among US elderly and disabled individuals, the majority of whom are covered by Medicare, a nationwide health insurance program administered by the US federal government. 10 Lack of data on the treatment of psoriasis in the elderly has been identified as a major research gap, 11 especially because they are often underrepresented in clinical trials and may have unique treatment concerns. 10,12 To address this gap, we examined national claims data for Medicare patients with psoriasis who were initiating biologics to investigate adherence, discontinuation, switching, and restarting of biologic treatment.…”

Prevalence of Phototherapy in the Age of Biologics

“…Or who have a contraindication to Absolute contraindications were always considered as exclusion criteria [4][5][6][7][8][9][10][11][12][13][14]. Contraception was suggested for men and women with methotrexate and only for women with acitretin and biologics, and its refusal was considered an exclusion criterion for those therapies [10] Relative contraindications were carefully evaluated individually, and treatment was not begun if they were not removed or controlled with adequate interventions [10] Drug interactions were carefully evaluated in each individual case.…”

“…Product information for the use of all biologics for psoriasis [3][4][5]13] in the present study. PUVA, psoralen and ultraviolet A light.…”