REAL-WORLD TREATMENT PATTERNS IN PATIENTS WITH PSORIATIC ARTHRITIS

BackgroundPsoriatic arthritis (PsA) is a complex inflammatory disease with manifestations that play an important role in treatment selection.1 Treatments include oral agents, biologic therapies (inhibitors of tumor necrosis factor [TNFi], interleukin [IL-17Ai, IL-12/23i], cytotoxic T lymphocyte–associated antigen 4 inhibitor [CTLA-4i]), and new targeted oral agents (inhibitors of phosphodiesterase-4 [PDE-4i] and Janus kinase [JAKi]).1 Few studies have examined real-world treatment patterns of recently approved therapies.ObjectivesEvaluate real-world treatment patterns for branded systemic therapy in patients with PsA.MethodsIn this retrospective study, medical and pharmacy claims from the US IBM MarketScan Commercial and Medicare databases (1/1/2012–12/31/2019) were used to identify patients with PsA who initiated treatment with a TNFi (adalimumab, etanercept, infliximab, golimumab, or certolizumab), IL-17Ai (secukinumab, ixekizumab), IL-12/23p40i (ustekinumab), IL-23p19i (guselkumab), CTLA-4i (abatacept), JAKi (tofacitinib), or PDE-4i (apremilast). Patients (≥18 years) with ≥1 prescription, ≥2 PsA claims separated by ≥1 day on or before the index date (first prescription date [1/1/13–12/31/2018]), and 1-year continuous enrollment before and after the index date were eligible. Treatment patterns were grouped into continuers, discontinuers, and patients with treatment modification (switchers [without a treatment gap], reinitiators [same drug with a treatment gap], and restarters [different drug with a treatment gap]) (Table 1). Patients were followed for 1 year or until treatment modification, whichever came first. Descriptive statistics were used.Table 1.TerminologyCohortDefinitionn/N (%)ContinuersOn index treatment during 1-year follow-up with no treatment gaps*1910/6455 (29.6)DiscontinuersNo prescription claims for any therapy during 1-year follow-up1614/6455 (25.0)Patients with treatment modificationsAll patients with a change in treatment during 1-year follow-up2908/6455 (45.1)SwitchersPrescription claims for treatments different than index therapy before permissible treatment gaps*794/6455 (12.3)ReinitiatorsPrescription claims for treatments SAME as index therapy AFTER treatment gaps*1686/6455 (26.1)RestartersPrescription claims for DIFFERENT therapy AFTER treatment gap*428/6455 (6.6)Note: All terminology applies to cohorts within the first year of treatment.*Treatment gap: gap of 200% of recommended dosing schedule from end of previous prescription’s days’ supply.ResultsA total of 6455 patients were included (mean age, 50.5 years; 55.5% female; mean Charlson Comorbidity Index score, 0.54). At baseline, the most commonly used therapies were immunosuppressants (58.5%), corticosteroids (52.2%), and nonsteroidal anti-inflammatory drugs (45.9%). Treatments most used at index were TNFi (72.5%; including adalimumab [41.6%] and etanercept [23.8%]) and the PDE-4i apremilast (21.1%). During the 1-year study period, 29.6% of patients maintained their index therapy and 25.0% discontinued. Treatment modification was observed in 45.1% of patients; 12.3% switched to a new therapy without a treatment gap, 26.1% restarted their index therapy, and 6.6% started a new therapy after a treatment gap.ConclusionAmong patients with PsA, there is substantial variability, including high rates of discontinuation within the first year and after index therapy. Further studies are warranted to understand reasons for these treatment patterns.References[1]Ogdie A et al. Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford). 2020;59(Suppl 1):i37-i46.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Statistical analysis support was provided by Arindom Borkakoti, formerly of Mu Sigma. Professional medical writing assistance was provided by LeeAnn Braun, MPH, MEd, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.Disclosure of InterestsJiyoon Choi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Antoine Sreih Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Manasi Suryavanshi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Qian Xia Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb