LB762 Initiation patterns among novel systemic agents for U.S. adults with Psoriasis and Psoriatic Arthritis

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Investigative Dermatology


Background: Biologic agents and PDE-4 inhibitors are a growing, but high cost drug class for severe psoriasis patients, especially those refractory to conventional therapies. Factors that drive treatment selection are unknown.

Type of Study: Retrospective cohort study.

Methods: Commercial and Medicare Advantage adult enrollees with a pharmacy claim for a TNF-a, IL-12/23, IL-17, or PDE-4 between 2015 and 2018 were grouped into psoriasis only (1-Ps, n=8013) or those with psoriasis plus psoriatic arthritis (2-Ps+PsA, n=5233). Multinomial logistic regression was used to generate odds ratios and 95% confidence intervals for receiving IL-12/23, IL-17, or PDE-4 compared with TNF-a and adjusted for demographics, prescriber specialty, insurance, and Charlson Comorbidity Index.

Results: TNF-a (referent) was the most common biologic for both groups (1-Ps 36%, 2-Ps+PsA 55%), followed by PDE-4 (1-Ps: 38%, 2-Ps+PsA: 27%), IL-12/23 (1-Ps: 21%, 2-Ps+PsA: 12%) and IL-17 (1-Ps: 5%, 2-Ps+PsA: 6%). Only 1.1% of 1-Ps patients were prescribed by a rheumatologist and 43% of 2-Ps+PsA. From 2015 to 2018, the proportion of IL-17 and PDE-4 increased, but TNF-a remained the most common. Prescribing of IL-12/23 is also increasing over time driven by the newer IL-23 medications. For 2-Ps+PsA patients, patients seen by rheumatologists were less likely to have a claim for non-TNF-a treatment i.e. IL-12/23 (OR=0.22[0.18-0.27)], IL-17 (0.36[0.28-0.46]) and PDE-4 (0.53[0.27-0.46]) versus those seen by dermatology. For 1-Ps, fills for IL-12/23 and PDE-4 (0.45[0.33-0.61], 0.48[0.38-0.60]) were less likely to be observed in Medicare compared to commercial.

Conclusion: IL-17 and PDE-4 inhibitors have been increasingly utilized compared to older biologics, however TNF-a remained the most commonly used. IL-23s should be monitored as their prescribing increases. Psoriasis type, insurance, and provider specialty were associated with selection of these agents.





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