Miyazaki Celine, Masuda Junya, Tsai Phiona I-Ching, Saeki Hidehisa
Value, Evidence and Access Department, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-ku, Tokyo, 101-0065, Japan.
Medical Affairs Division, Immunology and Infectious Disease Department, Janssen Pharmaceutical K.K., Tokyo, Japan.
Dermatol Ther (Heidelb). 2024 Nov;14(11):2999-3015. doi: 10.1007/s13555-024-01274-1. Epub 2024 Oct 15.
Poor persistence to biologics can result in suboptimal health outcomes and increased economic burden for chronic conditions, including psoriasis (PsO). In Japan, studies evaluating factors responsible for biologic treatment persistence in patients with PsO are limited. We assessed biologic treatment persistence (median treatment duration and overall treatment survival) and associated factors in patients with PsO in a real-world setting.
This retrospective analysis of insurance claims records from the Japan Medical Data Center (JMDC) database included patients with PsO [International Classification of Diseases (ICD) code: L40.x] ≥ 18 years of age who had received biologic treatment. Treatment persistence was analyzed using data from 2016 to 2020 by biologic class and by individual biologics (infliximab, adalimumab, ustekinumab, guselkumab, secukinumab, ixekizumab, and brodalumab) in bio-naïve (who initiate first biologic at index) and bio-experienced patients. Kaplan-Meier survival (treatment persistence), and multivariate Cox proportional hazard regression (predictive factors) analyses were used.
Overall, 1528 patients with PsO were included (mean age 47.4 years). Infliximab had the longest median treatment duration (33.6 months), while brodalumab had the shortest (9.7 months) among biologics evaluated. Of the biologics evaluated, 1-year treatment survival was highest with guselkumab (83%), and lowest with brodalumab (45%). Bio-experienced patients showed slightly longer median treatment duration than bio-naïve patients (22.8 versus 18.1 months). Factors predictive of treatment persistence were sex [male; hazard ratio (HR) 0.84, p = 0.016] and specific PsO diagnostic codes, such as L40.0 (PsO vulgaris; HR 0.69; p = 0.006), L40.1 (generalized pustular PsO; HR 0.75; p = 0.034), and L40.9 (PsO unspecified; HR 0.72; p = 0.001). Meanwhile, age and Charlson Comorbidity Index score were significantly associated with adalimumab and infliximab treatment persistence, respectively.
Among biologics evaluated, infliximab had the longest median treatment duration, and guselkumab had the highest 1-year treatment survival. Sex and specific PsO diagnostic codes influenced overall treatment persistence. These findings could inform long-term treatment plans for PsO in real-world clinical settings.
生物制剂治疗依从性差会导致健康结果不理想，并增加包括银屑病（PsO）在内的慢性病的经济负担。在日本，评估PsO患者生物制剂治疗依从性相关因素的研究有限。我们在真实世界环境中评估了PsO患者的生物制剂治疗依从性（中位治疗持续时间和总体治疗生存率）及相关因素。
这项对日本医疗数据中心（JMDC）数据库保险理赔记录的回顾性分析纳入了年龄≥18岁、接受过生物制剂治疗的PsO患者[国际疾病分类（ICD）编码：L40.x]。使用2016年至2020年的数据，按生物制剂类别和单个生物制剂（英夫利昔单抗、阿达木单抗、乌司奴单抗、古塞库单抗、司库奇尤单抗、依奇珠单抗和布罗达单抗），对初治（在索引时开始首次使用生物制剂）和经治患者的治疗依从性进行分析。采用Kaplan-Meier生存分析（治疗依从性）和多变量Cox比例风险回归分析（预测因素）。
总体而言，共纳入1528例PsO患者（平均年龄47.4岁）。在所评估的生物制剂中，英夫利昔单抗的中位治疗持续时间最长（33.6个月），而布罗达单抗最短（9.7个月）。在所评估的生物制剂中，古塞库单抗的1年治疗生存率最高（83%），布罗达单抗最低（45%）。经治患者的中位治疗持续时间略长于初治患者（22.8个月对18.1个月）。治疗依从性的预测因素为性别[男性；风险比（HR）0.84，p = 0.016]以及特定的PsO诊断编码，如L40.0（寻常型银屑病；HR 0.69；p = 0.006）、L40.1（泛发性脓疱型银屑病；HR 0.75；p = 0.034）和L40.9（未特指的银屑病；HR 0.72；p = 0.001）。同时，年龄和Charlson合并症指数评分分别与阿达木单抗和英夫利昔单抗的治疗依从性显著相关。
在所评估的生物制剂中，英夫利昔单抗的中位治疗持续时间最长，古塞库单抗的1年治疗生存率最高。性别和特定的PsO诊断编码影响总体治疗依从性。这些发现可为真实世界临床环境中PsO的长期治疗计划提供参考。
