Treatment Patterns Among Patients with Psoriatic Arthritis Treated with a Biologic in the United States: Descriptive Analyses from an Administrative Claims Database

Walsh, Jessica A.; Adejoro, Oluwakayode; Chastek, Benjamin; Palmer, Jacqueline B.; Hur, Peter

doi:10.18553/jmcp.2018.24.7.623

Cited by 22 publications

(19 citation statements)

References 44 publications

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“…We used inverse probability weighting for the average treatment effect of the treated weighting,24 with a propensity score to adjust for differences in baseline demographic and clinical characteristics between groups which may confound their drug treatment exposure. Propensity scores were calculated based on the probability of being exposed to either IL-17, IL-12/23 or TNF using multivariable logistic regression models 18 25. Weights were trimmed at 0.1 and 10 to minimise the influence of outliers 26.…”

Section: Methodsmentioning

confidence: 99%

Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis

Andersen

Chang

et al. 2019

Ann Rheum Dis

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ObjectiveTo examine whether initiation of interleukin (IL)-17, IL-12/23 or tumour necrosis factor (TNF) inhibitor is associated with an increased risk of serious infection among real-world psoriasis (PsO) or psoriatic arthritis (PsA) patients.MethodsWe assembled a retrospective cohort of commercially insured adults in the USA diagnosed with PsO or PsA between 2015 and 2018. Exposure was dispensation for IL-17 (ixekizumab or secukinumab), IL-12/23 (ustekinumab) or TNF (adalimumab, certolizumab pegol, etanercept, golimumab and infliximab). The outcome was infection requiring hospitalisation after biologic initiation. Incidence rates (IRs) per 100 person-years were computed, and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models, adjusted for inverse probability of treatment-weighted propensity scores.ResultsA total of 11 560 new treatment episodes were included. Overall, 190 serious infections (2% of treatment episodes) were identified in 9264 person-years of follow-up. Class-specific IRs were similar among IL-17 and TNF, yet significantly lower for IL-12/23. After adjustment for propensity scores, there was no increased risk with IL-17 compared with either TNF (HR=0.89, 95% CI 0.48 to 1.66) or IL-12/23 (HR=1.12, 95% CI 0.62 to 2.03). By contrast, IL-23/23 were associated with a lower risk of infections than TNF (HR=0.59, 95% CI 0.39 to 0.90).ConclusionsRelative to TNF and IL-17, IL-12/23 inhibitors were associated with a reduced risk of serious infection in biologic-naïve patients with PsO or PsA. In biologic-experienced individuals, there was no difference in infection risk across TNF, IL-17 or IL-12/23 inhibitors.

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Section: Methodsmentioning

confidence: 99%

Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis

Andersen

Chang

et al. 2019

Ann Rheum Dis

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“…Indeed, data from the BSR Biologics Register for Ankylosing Spondylitis indicate that in a real-world patient population around half of patients respond to TNF inhibition [6], compared to > 60% in the clinical trials that led to the licensing of these agents. Also, there is some evidence from a large claims database in the USA that the majority of patients commencing TNF or IL-12/ 23 inhibition had continued their index therapy within a twelve-month period [30]. Long-term studies have the opportunity to examine effectiveness of these agents in real-world clinical populations and allows the examination of patient sub-groups that are seldom available in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

The BSR-PsA: study protocol for the British Society for Rheumatology psoriatic arthritis register

et al. 2021

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Background Psoriatic arthritis (PsA) presents a unique clinical challenge. Affecting joints, skin, nails, and other organs, it is associated with various comorbidities and has a significant impact on quality of life, social participation and working life. While biologic and other targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs and tsDMARDs) have revolutionised therapy, questions remain about the long-term safety of these agents, and their effectiveness and cost-effectiveness in the real-world clinical setting. Methods/design The British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA) is a prospective registry of patients with PsA, recruited from across Great Britain, who are (a) commencing a bDMARD/tsDMARD; or (b) naïve to all bDMARDs/tsDMARDs. Ethical approval was given by the NHS West of Scotland Research Ethics Committee 3 (reference: 18/WS/0126). Clinical data are extracted from participants’ medical records, including symptom onset and diagnosis, joint, skin and nail symptoms, dactylitis and enthesitis. Physical measurements (height, weight and 66/68 joint counts) and a detailed drug history are taken. Participants are also asked to complete questionnaires comprising instruments relating to general health and quality of life, axial disease, sleep and fatigue, impact of disease, functional status, mental health, other symptoms, and occupational status. The study duration is 5 years in the first instance, and all participants are followed up annually until the end of the study. Participants commencing a bDMARD/tsDMARD are also followed up three and six months after the start of therapy. Disease activity, including C-reactive protein, is assessed at each visit; and participants from some centres are invited to donate blood and urine samples for the creation of a biobank. Discussion Complementing data from randomised trials, results from this study will contribute to the evidence base underpinning the clinical management of psoriatic arthritis. Various analyses will determine the effectiveness and safety of bDMARDs/tsDMARDs in the real-world, will examine the clinical and biological predictors of treatment response, and will provide real-world data on the cost-effectiveness of these therapies, as well as providing informative data important to patients such as quality of life and occupational outcomes. Trial registration The full study protocol is registered on the Open Science Framework (https://osf.io/jzs8n).

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“…We derived information from the claims data including individuals' age at index date, gender, race or ethnicity, educational level, income and Deyo Charlson Comorbidity Index score. 14 16 We also assessed information regarding use of treatments 6 months prior to index date including phototherapy, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), oral glucocorticoid use, opioid claims, as well as a count for the number of previous biologics including abatacept, brodalumab, guselkumab and tildrakizumab. 14 We assessed healthcare utilisation with inpatient and emergency department stays.…”

Section: Covariatesmentioning

confidence: 99%

“…14 16 We also assessed information regarding use of treatments 6 months prior to index date including phototherapy, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), oral glucocorticoid use, opioid claims, as well as a count for the number of previous biologics including abatacept, brodalumab, guselkumab and tildrakizumab. 14 We assessed healthcare utilisation with inpatient and emergency department stays. We also assessed the presence of chronic obstructive pulmonary disease, asthma, diabetes, fibromyalgia, any mood disorders and major depressive disorder (MDD) during any time before the index date.…”

Section: Covariatesmentioning

confidence: 99%

Comparative effectiveness of biologics and targeted therapies for psoriatic arthritis

et al. 2021

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ObjectiveTo quantify comparative effectiveness of interleukin (IL)−12/23 antagonist (ustekinumab), IL-17A antagonists (secukinumab and ixekizumab), PDE4 inhibitor (apremilast) and tumour necrosis factor-alpha (TNF-α) inhibitors (infliximab, etanercept, adalimumab, certolizumab pegol and golimumab) for psoriatic arthritis (PsA).MethodsWe adapted a deidentified claims-based algorithm validated for inflammatory arthritis treatments to compare treatments among a retrospective cohort of commercially insured and Medicare Advantage beneficiaries with PsA from October 2013 to April 2019 in the OptumLabs Data Warehouse. Main outcomes include (1) treatment effectiveness, based on: adherence, adding or switching biologic or PDE4, addition of new non-biologic disease-modifying antirheumatic drug, increase in biologic or PDE4 dose or frequency and glucocorticoid use and (2) percentage of each group fulfilling the effectiveness algorithm. We used Poisson regression with robust variance stratified by prior PsA biologic exposure and adjusted for potential confounders.ResultsOf 2730 individuals with PsA, 327 received IL-12/23, 138 IL-17A’s, 624 PDE4 and 1641 TNF-α’s. Effectiveness criteria were fulfilled among 63 (19.3%) IL-12/23 recipients, 40 (29.0%) IL-17A recipients, 160 (25.6%) PDE4 recipients and 530 (32.3%) TNF-α recipients. Among biologic-naïve individuals, IL-12/23 was less effective than TNF-α’s with fully adjusted relative risk (aRR) compared with TNF-α’s of 0.63 (95% CI 0.45 to 0.89). Among biologic-experienced individuals, PDE4 recipients were less effective than TNF-α’s (aRR 0.67, 95% CI 0.46 to 0.96).ConclusionsTNF-α’s appeared more effective than IL-12/23’s for biologic-naïve individuals, and PDE4’s for biologic-experienced individuals. These results may help inform treatment choice for individuals with PsA.

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Treatment Patterns Among Patients with Psoriatic Arthritis Treated with a Biologic in the United States: Descriptive Analyses from an Administrative Claims Database

Cited by 22 publications

References 44 publications

Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis

Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis

The BSR-PsA: study protocol for the British Society for Rheumatology psoriatic arthritis register

Comparative effectiveness of biologics and targeted therapies for psoriatic arthritis

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