Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:74

Article

Doshi, Jalpa A.^1,3  Takeshita, Junko^2,4  Pinto, Lionel⁵  Li, Penxiang^1,3  Yu, Xinyan^1,3  Rao, Preethi^3,6  Viswanathan, Hema N.⁵  Gelfand, Joel M.^2,4 

[1] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA

[2] Univ Penn, Dept Dermatol, Perelman Sch Med, Philadelphia, PA 19104 USA

[3] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA

[4] Univ Penn, Perelman Sch Med, Ctr Clin Epidemiol & Biostat, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA

[5] Amgen Inc, Thousand Oaks, CA 91320 USA

[6] Univ Penn, Wharton Sch, Hlth Care Management & Econ, Philadelphia, PA 19104 USA

关键词: adalimumab;    adherence;    biologic;    discontinuation;    etanercept;    infliximab;    Medicare;    psoriasis;    specialty drug;    ustekinumab;   

DOI  :  10.1016/j.jaad.2016.01.048

来源: Elsevier

【 摘 要 】

Background: Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population. Objective: We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab. Methods: We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting. Results: We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic. Limitations: Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data. Conclusion: Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.

【 授权许可】

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