LB762 Initiation patterns among novel systemic agents for U.S. adults with Psoriasis and Psoriatic Arthritis
Kwa M, Kang R, Cherupally M, Aikman C, and Ackermann R. LB762 Initiation patterns among novel systemic agents for U.S. adults with Psoriasis and Psoriatic Arthritis. J Invest Dermatol 2021; 141(9):B13.
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.