Treatment Changes in Patients With Moderate to Severe Psoriasis: A Retrospective Chart Review

Smith, Jaclyn A.; Wehausen, Brooke; Richardson, Irma; Zhao, Yang; Li, Yunfeng; Herrera, Vivian; Feldman, Steven R.

doi:10.1177/1203475417724438

Cited by 10 publications

(14 citation statements)

References 15 publications

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“…Rates of discontinuation and switching were high and generally higher in our study compared with previous studies in U.S. psoriasis patients with shorter follow-up periods [12,14]. Reasons for discontinuing or switching therapy may include lack of efficacy, loss of response over time, intolerance or AEs, inconveniently frequent dosing schedules, and drug affordability and availability issues [2,12,13,20,21]. Thus, our findings suggest that many psoriasis patients may be dissatisfied with their treatments, particularly over the long term.…”

Section: Discussionmentioning

confidence: 53%

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Real-world biologic and apremilast treatment patterns and healthcare costs in moderate-to-severe plaque psoriasis

Feldman¹,

Zhang²,

Martínez³

et al. 2021

Dermatology Online Journal

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Section: Discussionmentioning

confidence: 53%

“…Rates of combination therapy were also high at all time points in all treatment cohorts. As the primary reason for augmenting therapy is inadequate response [21], our results indicate that many patients may not be on the optimal treatment for long-term disease control.…”

Section: Discussionmentioning

confidence: 88%

Real-world biologic and apremilast treatment patterns and healthcare costs in moderate-to-severe plaque psoriasis

Feldman¹,

Zhang²,

Martínez³

et al. 2021

Dermatology Online Journal

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“…In addition, rates of combination therapy were high at all time points, regardless of index treatment, and were higher in patients with metabolic conditions. The primary reason for augmenting therapy is inadequate response to treatment (23), and thus our results suggest that many patients with metabolic comorbidities may not be on the optimal therapy for long-term psoriasis control.…”

Section: Discussionmentioning

confidence: 86%

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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“…Many treatment options are available for PSO and PsA, including topical agents, phototherapy, oral systemic agents and biologics. Of note, women of childbearing age (18-44 years) with PSO were reported to undergo more treatment changes than any other cohort assessed (i.e., men aged 18-44 years, men aged 45-65 years, and women aged 45-65 years), which can be an indicator of poor disease control (Anderson and Feldman, 2015, Smith et al, 2018) or increased focus on appearance. This group of patients was also the most likely to discontinue treatment (Lee et al, 2018).…”

Section: Treatment Of Psoriasis/psoriatic Arthritis and Options Compamentioning

confidence: 97%

Clinical considerations for the management of psoriasis in women

Gottlieb

Ryan

Murase

2019

International Journal of Women's Dermatology

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The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatization Questionnaire score; women: 93.2; men: 78.0), and reduced sexual activity (women: 33%; men: 19%) compared with men. The onset of psoriasis is bimodal, with one incidence peak (15-30 years) that coincides with the prime reproductive age for women, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Many women experience stabilization (21%) or improvement (55%) of their skin during pregnancy, but up to a quarter can experience disease worsening, and postpartum flares are common (> 50%). Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. Because half of pregnancies are unplanned, the implications of therapeutic options must be considered for all women with psoriasis who are sexually active, irrespective of intentions to start a family. Timely initiation of these discussions by health care professionals is paramount to prevent unintentional toxicity to the developing fetus. For example, acitretin, methotrexate, and oral psoralen/ultraviolet A are all contraindicated in pregnancy. Reassuringly, safety data for other psoriasis treatments during pregnancy are increasingly available, particularly for anti-tumor necrosis factor therapies. Despite encouraging data from pregnancy exposure registries and clinical studies now being included in anti-tumor necrosis factor drug labels, comfort with prescribing these therapies to pregnant women remains low (U.S. dermatologists: 21%; EU-5 dermatologists: 10%). In this article, we review issues specific to treating women of childbearing age with psoriasis and highlight the need for treatment guidelines to ensure consistent care and optimal outcomes for these patients.

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Treatment Changes in Patients With Moderate to Severe Psoriasis: A Retrospective Chart Review

Abstract: Biologic treatment options provide a major improvement over older systemic treatments, but patients still undergo frequent treatment changes to help control their disease.

Cited by 10 publications

References 15 publications

Real-world biologic and apremilast treatment patterns and healthcare costs in moderate-to-severe plaque psoriasis

Real-world biologic and apremilast treatment patterns and healthcare costs in moderate-to-severe plaque psoriasis

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

Clinical considerations for the management of psoriasis in women

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