Armstrong April, Xia Qian, John Anand Rojer, Patel Vardhaman, Seigel Lauren
Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
Bristol Myers Squibb, Princeton, NJ, USA.
Dermatol Ther (Heidelb). 2022 Sep;12(9):2087-2103. doi: 10.1007/s13555-022-00775-1. Epub 2022 Aug 10.
We aimed to evaluate US treatment patterns and, more specifically, switch patterns among patients with psoriasis (PsO) who initiated treatment with targeted therapy (TT) and subsequently switched to another therapy.
This retrospective study used IBM MarketScan Commercial and Medicare Databases (1/1/2006-3/31/2020) to evaluate treatment patterns in biologic- and apremilast-naive patients with PsO. TT included apremilast, adalimumab, etanercept, infliximab, ustekinumab, or other biologics (certolizumab pegol, secukinumab, brodalumab, ixekizumab, guselkumab, or tildrakizumab). Adults with ≥ 1 prescription for a TT, ≥ 2 PsO claims separated by ≥ 1 day on or before the index date (date of first TT prescription), and continuous medical and pharmacy enrollment for 1 year before and 2 years after the index date were eligible. Non-targeted therapy (NTT) was defined as non-targeted oral systemic treatment, topical treatment, phototherapy, or no treatment. Kaplan-Meier (KM) analysis was used to estimate time to reinitiation of TT (24-month continuous enrollment post-index was not required).
A total of 11,526 patients with PsO were included; mean [standard deviation (SD)] age and Charlson Comorbidity Index score were 48.3 (12.8) years and 0.9 (1.43), respectively. During the follow-up, 69.2% of the patients were treated with NTT. Median time to first NTT, for those who received NTT, was 205 days (longest: adalimumab, 252 days). Among patients who switched to NTT after initiating treatment with TT, 52.6% reinitiated treatment with TT (least common: apremilast, 45.6%), with a median time to reinitiation of 106 days (longest: other biologics, 136 days). For all patients on NTT, the probability of reinitiating any TT was 60.7% at 24 months.
PsO treatment is often cyclical in nature. Patients frequently experience drug holidays or transition back to TT after using NTT. The consideration of real-world treatment patterns in future economic models may provide new insights into the clinical effectiveness and value of PsO treatments.
我们旨在评估美国银屑病（PsO）患者的治疗模式，更具体地说，是评估那些开始接受靶向治疗（TT）并随后改用另一种治疗方法的患者的换药模式。
这项回顾性研究使用IBM MarketScan商业数据库和医疗保险数据库（2006年1月1日至2020年3月31日）来评估初治生物制剂和阿普米拉斯的PsO患者的治疗模式。TT包括阿普米拉斯、阿达木单抗、依那西普、英夫利昔单抗、乌司奴单抗或其他生物制剂（赛妥珠单抗、司库奇尤单抗、布罗达单抗、伊克西单抗、古塞库单抗或替拉珠单抗）。符合条件的成年人需满足：有≥1份TT处方，在索引日期（首次TT处方日期）或之前有≥2份间隔≥1天的PsO理赔记录，且在索引日期前1年和后2年连续进行医疗和药房登记。非靶向治疗（NTT）定义为非靶向口服全身治疗、局部治疗、光疗或不治疗。采用Kaplan-Meier（KM）分析来估计重新开始TT治疗的时间（索引后不需要连续登记24个月）。
共纳入11526例PsO患者；平均[标准差（SD）]年龄和Charlson合并症指数评分分别为48.3（12.8）岁和0.9（1.43）。在随访期间，69.2%的患者接受了NTT治疗。接受NTT治疗的患者首次接受NTT治疗的中位时间为205天（最长：阿达木单抗，252天）。在开始TT治疗后改用NTT的患者中，52.6%重新开始TT治疗（最不常见：阿普米拉斯，45.6%），重新开始治疗的中位时间为106天（最长：其他生物制剂，136天）。对于所有接受NTT治疗的患者，24个月时重新开始任何TT治疗的概率为60.7%。
PsO治疗本质上通常是周期性的。患者经常经历药物假期或在使用NTT后转回TT治疗。在未来的经济模型中考虑实际治疗模式可能会为PsO治疗的临床有效性和价值提供新的见解。
