Open access

Research Article

30 June 2021

Switch rates and total cost associated with apremilast and biologics in biologic-naive patients with psoriatic arthritis

Authors: David L Kaplan [email protected], Brian L Ung, Corey Pelletier, Chuka Udeze, Ibrahim Khilfeh, and Marc TianAuthor Info & Affiliations

Publication: Journal of Comparative Effectiveness Research

Volume 10, Number 12

https://doi.org/10.2217/cer-2020-0285

PDF OtherFormats

Abstract

Aim: Real-world treatment data for psoriatic arthritis are limited. We evaluated switch rates, adherence, and costs for patients initiating apremilast versus tumor necrosis factor inhibitor (TNFi) and interleukin inhibitor (ILi) among biologic-naive psoriatic arthritis patients. Materials & methods: This retrospective analysis used IBM MarketScan claims data to assess treatment switches, adherence and costs. Results: Twelve-month switch rates were significantly lower for apremilast versus TNFi (15.5% vs 26.6%; p < 0.0001) and similar to ILi (15.5% vs 14.0%; p = 0.71). Apremilast initiators had lower total costs versus TNFi and ILi (US$39,854 vs US$57,243 and US$65,687; p < 0.05) and adherence was slightly lower versus TNFi and higher versus ILi. Conclusion: Biologic-naive apremilast initiators had lower switch rates versus TNFi initiators and lower total costs versus TNFi or ILi initiators.

Supplementary Material

File (suppl_file.zip)

Download
111.21 KB

File (supplementary figure 1.docx)

Download
137.62 KB

File (supplementary table 1.docx)

Download
17.60 KB

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest

1.

Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum. Dis. Clin. North Am. 41(4), 545–568 (2015).

2.

Gladman DD, Antoni C, Mease P et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann. Rheum. Dis. 64(Suppl. 2), ii14–ii17 (2005).

3.

Alinaghi F, Calov M, Kristensen LE et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J. Am. Acad. Dermatol. 80(1), 251–265.e219 (2019).

4.

Kaine J, Song X, Kim G et al. Higher incidence rates of comorbidities in patients with psoriatic arthritis compared with the general population using U.S. administrative claims data. J. Manag. Care Spec. Pharm. 25(1), 122–132 (2019).

• This large retrospective cohort study using US claims data found that patients with psoriatic arthritis (PsA) had a high comorbidity burden, including cardiovascular disease, autoimmune disorders and other PsA-related comorbidities.

5.

Husted JA, Thavaneswaran A, Chandran V et al. Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. J. Rheumatol. 40(8), 1349–1356 (2013).

6.

Singh JA, Guyatt G, Ogdie A et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol. 71(1), 5–32 (2019).

7.

Gossec L, Smolen JS, Ramiro S et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann. Rheum. Dis. 75(3), 499–510 (2016).

8.

Alten R, Conaghan PG, Strand V et al. Unmet needs in psoriatic arthritis patients receiving immunomodulatory therapy: results from a large multinational real-world study. Clin. Rheumatol. 38(6), 1615–1626 (2019).

• This large multicountry survey study found that poor treatment response in patients with PsA is associated with decreased health-related quality of life and work productivity and when primary treatment failure occurs, timely switching is important.

9.

Otezla (apremilast) [package insert]. Amgen Inc., CA, USA (2020). www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/otezla/otezla_pi_english.ashx

10.

Kavanaugh A, Mease PJ, Gomez-Reino JJ et al. Treatment of psoriatic arthritis in a Phase III randomized, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann. Rheum. Dis. 73(6), 1020–1026 (2014).

11.

Kavanaugh A, Mease PJ, Gomez-Reino JJ et al. Longterm (52-week) results of a Phase III randomized, controlled trial of apremilast in patients with psoriatic arthritis. J. Rheumatol. 42(3), 479–488 (2015).

12.

Edwards CJ, Blanco FJ, Crowley J et al. Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement: a Phase III, randomised, controlled trial (PALACE 3). Ann. Rheum. Dis. 75(6), 1065–1073 (2016).

13.

Chastek B, White J, Van Voorhis D et al. A retrospective cohort study comparing utilization and costs of biologic therapies and JAK inhibitor therapy across four common inflammatory indications in adult US managed care patients. Adv. Ther. 33(4), 626–642 (2016).

14.

Wu JJ, Pelletier C, Ung B et al. Treatment patterns and healthcare costs among biologic-naive patients initiating apremilast or biologics for the treatment of psoriatic arthritis: results from a US claims analysis. Curr. Med. Res. Opin. 1–8 (2019).

•• In this large retrospective cohort study using US claims data, patients initiating treatment with apremilast had significantly lower healthcare costs than patients initiating treatment with a biologic, even when they switched to a biologic.

15.

Feldman SR, Pelletier CL, Wilson KL et al. Treatment patterns and costs among biologic-naive patients initiating apremilast or biologics for psoriatic arthritis. J. Comp. Eff. Res. 8(9), 699–709 (2019).

•• This large US claims database study found that patients with PsA initiating treatment with apremilast had adherence similar to patients initiating treatment with a biologic, but lower total healthcare costs.

16.

Mease PJ, Karki C, Liu M et al. Discontinuation and switching patterns of tumour necrosis factor inhibitors (TNFis) in TNFi-naive and TNFi-experienced patients with psoriatic arthritis: an observational study from the US-based Corrona registry. RMD Open 5(1), e000880 (2019).

•• The large US registry study found that TNF inhibitor-experienced patients had a shorter time to discontinuation and were more likely to discontinue or switch treatments compared with TNF inhibitor-naive patients.

17.

Lee MP, Lii J, Jin Y et al. Patterns of systemic treatment for psoriatic arthritis in the US: 2004–2015. Arthritis Care Res. (Hoboken) 70(5), 791–796 (2018).

18.

Lebwohl MG, Bachelez H, Barker J et al. Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J. Am. Acad. Dermatol. 70(5), 871–881 (2014).

19.

Palmer JB, Li Y, Herrera V et al. Treatment patterns and costs for anti-TNFalpha biologic therapy in patients with psoriatic arthritis. BMC Musculoskelet. Disord. 17, 261 (2016).

20.

Kaplan DL, Ung BL, Pelletier C et al. Switch rates and total cost of care associated with apremilast and biologic therapies in biologic-naive patients with plaque psoriasis. ClinicoEcon. Outcomes Res. 12369–12377 (2020).

•• This large retrospective cohort study using US claims data found that biologic-naive psoriasis patients initiating apremilast had lower switching rates compared with patients initiating TNF inhibitors, similar switching rates as patients initiating IL inhibitors, and lower costs compared with both treatments, primarily due to lower pharmacy costs.

21.

Burnier M. Is there a threshold for medication adherence? Lessons learnt from electronic monitoring of drug adherence. Front. Pharmacol. 9, 1540 (2018).

22.

Schwartzman S, Li Y, Zhou H et al. Economic impact of biologic utilization patterns in patients with psoriatic arthritis. Clin. Rheumatol. 36(7), 1579–1588 (2017).

23.

Edson-Heredia E, Zhu B, Lefevre C et al. Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using Clinical Practice Research Datalink. J. Eur. Acad. Dermatol. Venereol. 29(5), 955–963 (2015).

24.

Fernández-Carballido C, Martín-Martínez MA, García-Gómez C et al. Impact of comorbidity on physical function in patients with ankylosing spondylitis and psoriatic arthritis attending rheumatology clinics: results from a cross-sectional study. Arthritis Care Res. (Hoboken) 72(6), 822–828 (2020).

|