Most PsA patients discontinue initial biologic within 12 months

 

Most adult patients with psoriatic arthritis who newly initiate biologic therapy with a tumor necrosis factor (TNF) inhibitor or anti–interleukin-12/23 inhibitor discontinued the treatment before a year is up, according to a recent analysis of a U.S. claims database.

Over a 12-month follow-up period, 27% of psoriatic arthritis (PsA) patients discontinued the index biologic, 23% switched to a different biologic, and 6% discontinued the index biologic but later restarted it, according to the results, which were published in the Journal of Managed Care & Specialty Pharmacy.

Mitchel L. Zoler/Frontine Medical News

Treatment persistence is important to achieve optimal outcomes in PsA patients on biologic therapy, first author Jessica A. Walsh, MD, of the University of Utah, Salt Lake City, and her coauthors wrote in the report.

“In this population of patients with PsA, additional options for concomitant therapies or alternatives to TNF inhibitors and anti–IL-12/23 inhibitors may be important,” the authors wrote.

The retrospective, observational study included administrative claims data from the Optum research database representing 1,235 adults with PsA who newly initiated a biologic therapy between Jan. 1, 2013, and Jan. 31, 2015. The patients (53% female; mean age, 50.3 years) had received biologic therapies approved for treatment of PsA at the time. These patients had commercial health coverage or Medicare Advantage, and nearly half were from the South. About half (48%) received etanercept, 24% received adalimumab, 10% received infliximab, and the rest received golimumab, ustekinumab, or certolizumab pegol.

The mean duration of persistence with a newly initiated biologic was just 246 days, the investigators reported. Infliximab had the highest 12-month persistence in this study, investigators said, with a mean of 293 days, while certolizumab pegol had the shortest, at a mean of 207 days.

Among patients who stayed on the index biologic for at least 90 days, nearly half started an adjunctive treatment, which was usually corticosteroids (22%), opioids (17%), or an NSAID (13%), Dr. Walsh and her coauthors said.

 

Dose escalation of the index biologic occurred in 9.6% of patients over the 12-month follow-up, they added.

“High rates of discontinuation and switching of biologic therapies, along with high rates of dose escalation, suggest a high frequency of suboptimal biologic experience in patients with PsA,” they wrote. Although the study did not address why patients discontinued or switched, previous studies suggest adverse effects and lack of efficacy are the most commonly reported reasons.

“Insufficient control of symptoms may lead patients to discontinue biologic therapy, which can contribute to disease progression,” the authors said in their conclusion.

Novartis sponsored the study. Some study authors reported disclosures related to Novartis, including consultancy and employment, and to Optum, which was commissioned to conduct the study.

SOURCE: Walsh JA et al. J Manag Care Spec Pharm. 2018 Mar 20. doi: 10.18553/jmcp.2018.17388.

 

Most adult patients with psoriatic arthritis who newly initiate biologic therapy with a tumor necrosis factor (TNF) inhibitor or anti–interleukin-12/23 inhibitor discontinued the treatment before a year is up, according to a recent analysis of a U.S. claims database.

Over a 12-month follow-up period, 27% of psoriatic arthritis (PsA) patients discontinued the index biologic, 23% switched to a different biologic, and 6% discontinued the index biologic but later restarted it, according to the results, which were published in the Journal of Managed Care & Specialty Pharmacy.

Mitchel L. Zoler/Frontine Medical News

Treatment persistence is important to achieve optimal outcomes in PsA patients on biologic therapy, first author Jessica A. Walsh, MD, of the University of Utah, Salt Lake City, and her coauthors wrote in the report.

“In this population of patients with PsA, additional options for concomitant therapies or alternatives to TNF inhibitors and anti–IL-12/23 inhibitors may be important,” the authors wrote.

The retrospective, observational study included administrative claims data from the Optum research database representing 1,235 adults with PsA who newly initiated a biologic therapy between Jan. 1, 2013, and Jan. 31, 2015. The patients (53% female; mean age, 50.3 years) had received biologic therapies approved for treatment of PsA at the time. These patients had commercial health coverage or Medicare Advantage, and nearly half were from the South. About half (48%) received etanercept, 24% received adalimumab, 10% received infliximab, and the rest received golimumab, ustekinumab, or certolizumab pegol.

The mean duration of persistence with a newly initiated biologic was just 246 days, the investigators reported. Infliximab had the highest 12-month persistence in this study, investigators said, with a mean of 293 days, while certolizumab pegol had the shortest, at a mean of 207 days.

Among patients who stayed on the index biologic for at least 90 days, nearly half started an adjunctive treatment, which was usually corticosteroids (22%), opioids (17%), or an NSAID (13%), Dr. Walsh and her coauthors said.

 

Dose escalation of the index biologic occurred in 9.6% of patients over the 12-month follow-up, they added.

“High rates of discontinuation and switching of biologic therapies, along with high rates of dose escalation, suggest a high frequency of suboptimal biologic experience in patients with PsA,” they wrote. Although the study did not address why patients discontinued or switched, previous studies suggest adverse effects and lack of efficacy are the most commonly reported reasons.

“Insufficient control of symptoms may lead patients to discontinue biologic therapy, which can contribute to disease progression,” the authors said in their conclusion.

Novartis sponsored the study. Some study authors reported disclosures related to Novartis, including consultancy and employment, and to Optum, which was commissioned to conduct the study.

SOURCE: Walsh JA et al. J Manag Care Spec Pharm. 2018 Mar 20. doi: 10.18553/jmcp.2018.17388.

 

Most adult patients with psoriatic arthritis who newly initiate biologic therapy with a tumor necrosis factor (TNF) inhibitor or anti–interleukin-12/23 inhibitor discontinued the treatment before a year is up, according to a recent analysis of a U.S. claims database.

Over a 12-month follow-up period, 27% of psoriatic arthritis (PsA) patients discontinued the index biologic, 23% switched to a different biologic, and 6% discontinued the index biologic but later restarted it, according to the results, which were published in the Journal of Managed Care & Specialty Pharmacy.

Mitchel L. Zoler/Frontine Medical News

Treatment persistence is important to achieve optimal outcomes in PsA patients on biologic therapy, first author Jessica A. Walsh, MD, of the University of Utah, Salt Lake City, and her coauthors wrote in the report.

“In this population of patients with PsA, additional options for concomitant therapies or alternatives to TNF inhibitors and anti–IL-12/23 inhibitors may be important,” the authors wrote.

The retrospective, observational study included administrative claims data from the Optum research database representing 1,235 adults with PsA who newly initiated a biologic therapy between Jan. 1, 2013, and Jan. 31, 2015. The patients (53% female; mean age, 50.3 years) had received biologic therapies approved for treatment of PsA at the time. These patients had commercial health coverage or Medicare Advantage, and nearly half were from the South. About half (48%) received etanercept, 24% received adalimumab, 10% received infliximab, and the rest received golimumab, ustekinumab, or certolizumab pegol.

The mean duration of persistence with a newly initiated biologic was just 246 days, the investigators reported. Infliximab had the highest 12-month persistence in this study, investigators said, with a mean of 293 days, while certolizumab pegol had the shortest, at a mean of 207 days.

Among patients who stayed on the index biologic for at least 90 days, nearly half started an adjunctive treatment, which was usually corticosteroids (22%), opioids (17%), or an NSAID (13%), Dr. Walsh and her coauthors said.

 

Dose escalation of the index biologic occurred in 9.6% of patients over the 12-month follow-up, they added.

“High rates of discontinuation and switching of biologic therapies, along with high rates of dose escalation, suggest a high frequency of suboptimal biologic experience in patients with PsA,” they wrote. Although the study did not address why patients discontinued or switched, previous studies suggest adverse effects and lack of efficacy are the most commonly reported reasons.

“Insufficient control of symptoms may lead patients to discontinue biologic therapy, which can contribute to disease progression,” the authors said in their conclusion.

Novartis sponsored the study. Some study authors reported disclosures related to Novartis, including consultancy and employment, and to Optum, which was commissioned to conduct the study.

SOURCE: Walsh JA et al. J Manag Care Spec Pharm. 2018 Mar 20. doi: 10.18553/jmcp.2018.17388.