Background PsA is a chronic immune mediated disorder with skin and joint manifestations. Existing treatment patterns have not been well characterized in PsA given diverse manifestations and a wide range of disease severity.
Objectives To describe treatment patterns in PsA patients (pts) newly treated with oral DMARDs.
Methods Continuously enrolled adult pts with ≥2 PsA diagnoses (ICD-9-CM code: 696.0x), newly initiated on an oral DMARD were selected from the MarketScan Commercial Claims database (2005-2009), which contains pt-specific health data including clinical utilization, expenditures, insurance enrollment, inpatient, outpatient, and prescription information. Only pts who did not use any DMARDs (biologic/non-biologic) for ≥6 months prior to the index date (date of the first DMARD prescription) were selected. Treatment patterns were captured over the one-year study period following the index date. Treatment discontinuation was defined as a treatment gap of ≥60 consecutive days between the last day of supply of one prescription and the refill date of the next prescription. Therapy modification, a switch/add-on, was defined as the initiation of a new oral DMARD, biologic, NSAID, or glucocorticoids that was not used at the index date. Therapy modification rates were reported over the one-year study period. In addition, as pts might experience >1 of the study therapy changes over the one-year period, the proportion of pts who switched to/added-on a biologic directly from the index therapy was also reported. Analyses of treatment changes were performed among all pts as well as for the subgroup of pts initiated on MTX at the index date.
Results Overall, 4,772 PsA pts met eligibility criteria. Over the one-year study period, 83% of the pts experienced ≥1 treatment change (either a discontinuation or a switch/add-on). The median time to treatment change was 72 days. More specifically, 60% of the pts discontinued the index treatment (median time: 90 days); 37% had a switch/add-on of an NSAID/glucocorticoids (median time: 102 days), 19% had a switch/add-on of another non-biologic DMARD (median time: 123 days), and 31% had a switch/add-on of a biologic (median time: 137 days). Among pts who switched to/added-on a biologic, 85% switched/added-on directly from the index DMARD to a biologic, while 15% of them used ≥1 other DMARD in between.
Among the subgroup of pts newly initiated on MTX (N=3,113), 81% experienced ≥1 treatment change with a median time of 83 days. More specifically, within the study period, 54% of the pts discontinued MTX treatment (median time: 100 days); 37% had a switch/add-on of an NSAID/glucocorticoid (median time: 99 days), 11% had a switch/add-on of another non-biologic DMARD (median time: 150 days), and 36% had a switch/add-on of a biologic (median time: 129 days). Direct switch/add-on from MTX to a biologic therapy was observed in 93% of the pts who switched to/added-on a biologic.
Conclusions This study suggests that PsA pts newly initiated on a DMARD do not remain on the index therapy for a long period of time, and biologic use started early in a significant proportion of pts. A better understanding of factors related to these treatment changes are needed to better inform unmet needs in PsA pts.
Disclosure of Interest F. Zhang Employee of: Celgene Corporation, A. Guerin Employee of: Analysis Group Inc. which received consultancy fees from Celgene Corporation, G. Gauthier Employee of: Analysis Group, Inc., which received consultancy fees from Celgene Corporation., J. Curtis Grant/Research support from: amgen, abbott, janssen, celgene, UCB, CORRONA, Crescendo, Pfizer, BMS, Genentech/Roche, Consultant for: amgen, abbott, janssen, celgene, UCB, CORRONA, Crescendo, Pfizer, BMS, Genentech/Roche
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