Blauvelt Andrew, Shi Nianwen, Burge Russel, Malatestinic William N, Lin Chen-Yen, Lew Carolyn R, Zimmerman Nicole M, Goldblum Orin M, Zhu Baojin, Murage Mwangi J
Oregon Medical Research Center, Portland, OR, USA.
IBM Watson Health, Cambridge, MA, USA.
Patient Prefer Adherence. 2020 Mar 9;14:517-527. doi: 10.2147/PPA.S233993. eCollection 2020.
There is lack of real-world treatment pattern comparison data between ixekizumab and adalimumab which are approved for the treatment of moderate-to-severe plaque psoriasis.
To compare real-world treatment patterns among psoriasis patients initiating ixekizumab or adalimumab in the United States.
Psoriasis patients with ≥1 claim for ixekizumab or adalimumab between March 1, 2016, and May 31, 2018, were identified (index date = date of first ixekizumab or adalimumab claim) from the IBM Watson Health MarketScan databases. Patients were required to be continuously enrolled for ≥12 months before the index date and followed for a minimum of 6 months until inpatient death, enrollment end, or study end, whichever occurred first. Treatment persistence, adherence, discontinuation, restart, and switching were analyzed. Inverse probability of treatment weighting and multivariable regression modeling were employed to address cohort imbalances and estimate the adjusted risk of non-persistence, discontinuation, and switching, and the odds of adherence.
A total of 646 ixekizumab and 3668 adalimumab users were included and followed for a mean of 14.0 and 16.5 months, respectively. Compared to adalimumab, ixekizumab was associated with 19% lower risk of non-persistence (hazard ratio [HR]=0.81, 95% confidence interval [CI]: 0.69-0.95), 26% lower risk of discontinuation (HR=0.74, 95% CI: 0.62-0.88), and 28% lower risk of switching (HR=0.72, 95% CI: 0.57-0.91). Ixekizumab users had higher odds of medication possession ratio ≥80% (odds ratio [OR]=1.36, 95% CI: 1.10-1.69) but similar odds by proportion of days covered ≥80% (OR=1.22, 95% CI: 0.98-1.53).
Psoriasis patients treated with ixekizumab demonstrated longer persistency, higher adherence and were less likely to discontinue or switch treatment compared to adalimumab users. However, while patients achieving highly adherent threshold significantly differed by MPR ≥80%, it did not by PDC ≥80%; hence, further analysis using fixed-length follow-up is required.
对于已获批用于治疗中度至重度斑块状银屑病的司库奇尤单抗和阿达木单抗，缺乏真实世界中的治疗模式对比数据。
比较美国开始使用司库奇尤单抗或阿达木单抗的银屑病患者的真实世界治疗模式。
从IBM Watson Health MarketScan数据库中识别出在2016年3月1日至2018年5月31日期间有≥1次司库奇尤单抗或阿达木单抗用药记录的银屑病患者（索引日期=首次司库奇尤单抗或阿达木单抗用药记录日期）。患者在索引日期前需连续登记≥12个月，并随访至少6个月，直至住院死亡、登记结束或研究结束，以先发生者为准。分析治疗持续性、依从性、停药、重新开始用药和换药情况。采用治疗权重逆概率法和多变量回归模型来解决队列不均衡问题，并估计调整后的非持续性、停药和换药风险以及依从性几率。
共纳入646名司库奇尤单抗使用者和3668名阿达木单抗使用者，平均随访时间分别为14.0个月和16.5个月。与阿达木单抗相比，司库奇尤单抗的非持续性风险降低19%（风险比[HR]=0.81，95%置信区间[CI]：0.69 - 0.95），停药风险降低26%（HR=0.74，95% CI：0.62 - 0.88），换药风险降低28%（HR=0.72，95% CI：0.57 - 0.91）。司库奇尤单抗使用者药物持有率≥80%的几率更高（优势比[OR]=1.36，95% CI：1.10 - 1.69），但按覆盖天数比例≥80%计算的几率相似（OR=1.22，95% CI：0.98 - 1.53）。
与阿达木单抗使用者相比，接受司库奇尤单抗治疗的银屑病患者表现出更长的持续性、更高的依从性，且停药或换药的可能性更小。然而，虽然达到高依从性阈值的患者在MPR≥80%时有显著差异，但在PDC≥80%时并无差异；因此，需要使用固定长度随访进行进一步分析。
