Xu Chang, Teeple Amanda, Wu Bingcao, Fitzgerald Timothy, Feldman Steven R
Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA.
Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Dermatology. 2022;238(3):438-447. doi: 10.1159/000519176. Epub 2021 Oct 28.
Adalimumab (ADA), certolizumab pegol (CER), etanercept (ETA), guselkumab (GUS), ixekizumab (IXE), secukinumab (SEC), and ustekinumab (UST) are biologic medications approved in the USA for the treatment of moderate to severe psoriasis. We examined drug adherence and persistence of patients with moderate to severe psoriasis who initiated these seven biologic medications.
Adult patients with ≥1 pharmacy/medical claim for any of the seven psoriasis medications and ≥1 diagnosis of psoriasis in the previous 6 months between July 1, 2014 and June 30, 2019 were selected from the IBM MarketScan® Commercial Claims and Encounters Database. The index date was defined as the date of the first prescription fill. Patients were required to have continuous health plan enrollment during the 6 months prior to their index date and ≥9 months after. Patients were grouped into seven study cohorts based upon their index biologic medication. Adherence was measured using the proportion of days covered (PDC) and defined by a PDC ≥80%. Adherence and persistence with index biologic medications were examined during fixed follow-up periods of 3, 6, and 9 months, with a subpopulation analysis carried out among patients with 12 months of follow-up.
Among psoriasis patients with ≥9 months of continuous enrollment included in the study population, the number of those who initiated each biologic medication was 10,324 for ADA, 431 for CER, 3,092 for ETA, 821 for GUS, 1,766 for IXE, 4,132 for SEC, and 5,441 for UST. The mean age at the time of initiating biologic treatment was 46.9 years. During the 9-month follow-up period, the proportions of adherent patients (i.e., PDC ≥80%) were numerically higher among those treated with UST (59.9%) and GUS (56.9%), followed by those treated with SEC (46.1%), IXE (45.5%), ADA (44.7%), ETA (33.9%), and CER (22.0%). The proportions of patients who were persistent with their index biologic medication during the 9-month follow-up period were numerically higher among those treated with UST (70.1%) and GUS (67.8%), followed by those treated with IXE (47.3%), SEC (46.9%), ADA (28.7%), CER (14.8%), and ETA (10.7%).
In this large healthcare claims database analysis of psoriasis patients treated with seven different biologic medications, adherence was numerically higher among those treated with UST or GUS. UST and GUS were also associated with numerically greater persistence.
阿达木单抗（ADA）、赛妥珠单抗（CER）、依那西普（ETA）、古塞库单抗（GUS）、司库奇尤单抗（IXE）、苏金单抗（SEC）和乌司奴单抗（UST）是美国批准用于治疗中度至重度银屑病的生物药物。我们研究了开始使用这七种生物药物的中度至重度银屑病患者的药物依从性和持续性。
从IBM MarketScan®商业索赔和病历数据库中选取2014年7月1日至2019年6月30日期间有≥1次使用这七种银屑病药物之一的药房/医疗索赔且在过去6个月内有≥1次银屑病诊断的成年患者。索引日期定义为首次处方配药日期。患者在索引日期前6个月和之后≥9个月需要持续参加健康计划。根据患者索引生物药物将其分为七个研究队列。使用覆盖天数比例（PDC）来衡量依从性，PDC≥80%定义为依从。在3个月、6个月和9个月的固定随访期内检查索引生物药物的依从性和持续性，并对随访12个月的患者进行亚组分析。
在纳入研究人群的持续登记≥9个月的银屑病患者中，开始使用每种生物药物的人数分别为：ADA 10324人、CER 431人、ETA 3092人、GUS 821人、IXE 1766人、SEC 4132人、UST 5441人。开始生物治疗时的平均年龄为46.9岁。在9个月的随访期内，接受UST治疗的患者（59.9%）和GUS治疗的患者（56.9%）中依从患者（即PDC≥80%）的比例在数值上更高，其次是接受SEC治疗的患者（46.1%）、IXE治疗的患者（45.5%）、ADA治疗的患者（44.7%）、ETA治疗的患者（33.9%）和CER治疗的患者（22.0%）。在9个月的随访期内持续使用索引生物药物的患者比例在数值上更高的是接受UST治疗的患者（70.1%）和GUS治疗的患者（67.8%），其次是接受IXE治疗的患者（47.3%）、SEC治疗的患者（46.9%）、ADA治疗的患者（28.7%）、CER治疗的患者（14.8%）和ETA治疗的患者（10.7%）。
在这个对接受七种不同生物药物治疗的银屑病患者的大型医疗索赔数据库分析中，接受UST或GUS治疗的患者依从性在数值上更高。UST和GUS在数值上也与更高的持续性相关。
