Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Am Acad Dermatol. 2018 Dec;79(6):1061-1068.e1. doi: 10.1016/j.jaad.2018.06.053. Epub 2018 Jul 5.
Nonadherence to systemic treatments for psoriasis leads to treatment failure and increased health care utilization.
Examine drug utilization patterns and adherence of new users of systemic medications for psoriasis.
We conducted a retrospective, comparative cohort study using a large US health insurance claims database including psoriasis patients who were new users of acitretin, adalimumab, etanercept, methotrexate, or ustekinumab. Adherence was measured by using proportion of days covered dichotomized as adherent (≥0.80) or nonadherent (<0.80). Odds ratios (ORs) and 95% confidence intervals (CIs) comparing adherence to each exposure (acitretin, adalimumab, etanercept, or ustekinumab) to the referent (methotrexate) were estimated via logistic regression, with pairwise 1:1 propensity score matching to adjust for potential confounders.
In total, 22,742 patients were new users of systemic medications. Among these patients, adherence to adalimumab (OR 2.24, 95% CI 2.05-2.45); etanercept (OR 1.77, 95% CI 1.63-1.92); and ustekinumab (OR 2.54, 95% CI 2.24-2.87) was greater and acitretin (OR 0.57, 95% CI 0.50-0.63) lower compared with methotrexate.
Unable to evaluate reasons for discontinuation.
We report greater adherence to biologics than methotrexate in new users. Further research is needed to understand overall low adherence to systemic medications for psoriasis.
银屑病患者不遵医嘱系统治疗会导致治疗失败和增加医疗保健的利用。
检查新使用系统性药物治疗银屑病患者的药物使用模式和依从性。
我们进行了一项回顾性、比较队列研究，使用了一个大型美国健康保险索赔数据库，包括新使用阿维 A、阿达木单抗、依那西普、甲氨蝶呤或乌司奴单抗的银屑病患者。通过使用覆盖比例的二分法（≥0.80 为依从，<0.80 为不依从）来衡量依从性。通过逻辑回归比较每种暴露（阿维 A、阿达木单抗、依那西普或乌司奴单抗）与参照（甲氨蝶呤）的依从性，使用配对 1:1 倾向评分匹配来调整潜在混杂因素。
共有 22742 名患者新使用了系统性药物。在这些患者中，阿达木单抗（OR 2.24，95%CI 2.05-2.45）、依那西普（OR 1.77，95%CI 1.63-1.92）和乌司奴单抗（OR 2.54，95%CI 2.24-2.87）的依从性更高，而阿维 A（OR 0.57，95%CI 0.50-0.63）的依从性更低。
无法评估停药的原因。
我们报告新使用者对生物制剂的依从性高于甲氨蝶呤。需要进一步研究以了解银屑病系统性药物整体低依从性的原因。
