A Majority of Patients With PsA Discontinue Their First Biologic Before 12 Months

Psoriatic arthritis (PsA) may be treated with the anti—tumor necrosis factor (anti-TNF) agents adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab, or with the anti—interleukin (IL)-12/23 therapy ustekinumab, or other biologics, but few data are available about treatment patterns in patients with PsA.

A study recently published in the Journal of Managed Care and Specialty Pharmacy, which used US administrative claims data from the Optum Research Database from 2012 to 2016, sought to examine the treatment patterns and modifications in US adult patients with PsA who were receiving biologic therapy with an anti-TNF agent or an anti—IL-12/23 drug.

A total of 1235 patients with a newly initiated biologic treatment were included in the study. The greatest number of patients received etanercept (n = 549, 48.1%), followed by adalimumab (n = 296, 24.0%), infliximab (n = 129, 10.4%), golimumab (n = 103, 8.3%), ustekinumab (n = 89, 7.2%), and certolizumab pegol (n = 25, 2.0%).

Adherence was measured in terms of proportion of days covered (PDC) in 12 months, and persistence was measured as the number of days from the index date to the date of discontinuation or switching of therapy.

The mean and median PDC for all of the drugs evaluated were 0.59 (standard deviation [SD], 0.30) and 0.66 (interquartile range [IQR], 0.31-0.88), respectively. Patients who received infliximab had the highest mean PDC at 0.77 (SD, 0.28), and those who received certolizumab pegol had the lowest PDC at 0.51 (SD, 0.30).

The mean and median persistence with biologic therapy were 246 days (SD, 128) and 303 days (IQR, 117-365), respectively. Similar to the PDC findings, those who received infliximab had the longest mean persistence at 293 days, and those who initiated certolizumab pegol had the shortest at 207 days.

Overall, only 44.5% of patients persisted with their index biologic for 12 months or more. Infliximab had the highest rate of persistence at 12 months (61.2%) and certolizumab pegol had the lowest (32.0%). Among those who were not persistent with their index drug, 26.8% discontinued treatment without switching or restarting, 5.8% discontinued and subsequently restarted the index drug, and 22.9% switched treatments (among this group, the mean time to switch was approximately 6 months, and most patients switched to adalimumab or etanercept).

Of the patients who persisted with their treatment for more than 90 days, 92.1% received 1 or more concomitant medication, such as a corticosteroid, conventional synthetic disease-modifying anti-rheumatic, or opioid. Furthermore, 9.6% of these patients had a dose escalation of the index biologic.

“High rates of discontinuation and switching of biologic therapies, along with high rates of dose escalation, suggest a high frequency of suboptimal biologic experience in patients with PsA,” write the authors, who call for more research to help guide patients and clinicians in making decisions about choosing first- and second-line therapies for PsA.

Reference

Walsh JA, Adejoro O, Chastek B, Palmer JB, Hur P. Treatment patterns among patients with psoriatic arthritis treated with a biologic in the United States: descriptive analyses from an administrative claims database. J Manag Care Spec Pharm. 2018;24(7):623-631. doi: 10.18553/jmcp.2018.24.7.623.