Use of Biological Drugs for Psoriasis: A Drug-Utilization Study Using Tuscan Administrative Databanks

Abstract

Our study aims at providing evidence on patterns of use of biologic drugs for psoriasis in Tuscany, Italy. We conducted a drug-utilization study based on administrative databanks of Tuscany (EUPAS45365) from 2011 to 2019. We selected new users of etanercept, infliximab, adalimumab, ustekinumab, or secukinumab between 1 January 2011 and 31 December 2016. We considered subjects with psoriasis and followed subjects until the end of the study period (three years after the first dispensation of biologic drug for psoriasis) or the patient’s death, whichever came first. We censored subjects for pregnancy or neoplasia. For each subject, we defined the state as the weekly coverage of one of the biologic drugs of interest. We then defined the switch as the change from a state to another one. A total of 7062 subjects with a first dispensation of a PSObio drug in the inclusion period was identified, and 1839 (52.9% female, 51.6 mean age) patients were included in the analysis. Among new users of adalimumab (N = 770, 41.9%), one third showed a continuous behaviour whereas the others moved to etanercept and ustekinumab. New users of etanercept (N = 758, 41.2%), had the highest proportion of switchers, with adalimumab most often being the second choice. New users of infliximab (N = 159, 8.6%) experienced the highest proportion of treatment discontinuation. The present study suggests that the majority of patients treated with PSObio drugs do not switch from one active ingredient to another. However, patients who started biological therapy with etanercept had the highest frequency of switching to other PSObio drugs, whereas those who started with secukinumab or ustekinumab had the lowest.

Drug Utilization and Measurement of Medication Adherence: A Real World Study of Psoriasis in Italy

“…Feldman’s study highlighted even lower persistence with anti-TNF agents, considering longer follow-up periods at 12, 18, and 24 months. The observed low persistence with apremilast is consistent with previous findings as described by Feldman SR and others [ 31 , 33 ]. These findings suggest multiple factors contributing to poor persistence, including potential drug inefficiency, loss of response over time, and the occurrence of adverse events [ 27 , 28 ].…”

“…These findings seem to align with previous literature, highlighting low rates of therapy switches [ 31 , 32 , 33 , 34 ]. Specifically, in the Italian context, Giometto et al (2022) reported a low overall switch rate (20%) with anti-IL drugs [ 30 ].…”

“…Recent clinical evidence has revealed that therapeutic swaps, specifically, can lead to additional improvements that may have a positive impact on patients’ quality of life. It is worth noting that much of the existing clinical evidence on medication changes primarily focuses on switches while overlooking the intricacies associated with therapeutic swaps [ 16 , 31 , 32 , 33 , 34 ]. Our dataset revealed that, overall, 93% of patients initiated the first prescribed therapy.…”