PBI41 TREATMENT PATTERNS OF BIOLOGICS AND APREMILAST AMONG PATIENTS WITH MODERATE TO SEVERE PLAQUE PSORIASIS BY PSORIATIC ARTHRITIS STATUS

Long-term real-world treatment patterns of psoriasis patients are not well characterized, especially those with psoriatic arthritis (PsA). This study compared the treatment patterns of psoriasis patients with and without PsA, who newly initiated a biologic or apremilast (APR). Using the MarketScan Commercial and Medicare databases, adult patients with psoriasis were classified into 5 mutually exclusive cohorts based on their initial index medication between 01/01/2015 and 08/31/2018: secukinumab (SEC), adalimumab (ADA), ustekinumab (UST), etanercept (ETA), or APR. No index medication use in the 12-month pre-index, and continuous medical and pharmacy benefits in the pre-index and 24-month post-index periods were required. Subgroups were created by the presence of PsA in the 12-month pre-index period. Discontinuation (treatment gaps [weeks]: ETA and APR, 4; ADA, 8; SEC, 10; and UST, 18), adherence (proportion of days covered), and switching were compared within each cohort using Wilcoxon rank-sum test. This study included 275, 2,684, 910, 1,063, and 2,841 patients for SEC, ADA, UST, ETA, and APR, respectively, and the proportions of patients with PsA were 35.3%, 35.1%, 22.0%, 45.7%, and 24.8%, respectively. Discontinuation rates for patients with and without PsA were: SEC: 54.6% vs. 43.8%; ADA: 48.3% vs. 53.0%; UST: 52.5% vs. 34.4%; ETA: 38.1% vs. 45.4%; APR: 47.7% vs. 43.4% (all p<0.05 except SEC). Adherence rates were: SEC: 0.54 vs. 0.57; ADA: 0.52 vs. 0.50; UST*: 0.44 vs. 0.52; ETA*: 0.50 vs. 0.43; APR: 0.44 vs. 0.45. *p<0.05). Overall switching rates were high for all groups. Many moderate-to-severe PsO patients who initiated biologics or APR had PsA. Among UST and APR cohorts, patients with PsA had higher discontinuation and lower adherence compared with patients without PsA. As patients with or without PsA had high switching rates, treatments that overcome the hurdle of poor adherence to self-administration may be helpful.