Treatment patterns among patients with psoriasis using a large national payer database in the United States: a retrospective study |
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Authors: | Mwangi J Murage David M Kern Lawrence Chang Kalyani Sonawane William N Malatestinic Ralph A Quimbo |
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Institution: | 1. Eli Lilly and Company, Indianapolis, IN, USA;2. HealthCore, Inc., Wilmington, DE, USA |
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Abstract: | Aim: To characterize treatment patterns of psoriasis patients in a large US managed care database.Materials and methods: Adults with newly-diagnosed psoriasis were identified from July 3, 2006–August 31, 2014. Patients had continuous enrollment with medical and pharmacy benefits for ≥6 months prior to and ≥1 year following the index date. The index date was the point at which any of the following inclusion criteria were satisfied: first psoriasis diagnosis by a dermatologist, ≥ 2 psoriasis diagnoses ≥30 days apart, or a diagnosis of psoriasis followed by a claim for psoriasis therapy. Of primary interest was to measure and describe the following psoriasis treatment patterns: utilization rates, time to treatment discontinuation, and lines of therapy for various therapeutic classes of pharmacologic therapies.Results: From the 128,308 patients identified, 53% were female, mean?±?SD age was 50?±?16 years, with median 3 years follow-up. Topicals were received by 86% of patients, non-biologic systemics by 13%, biologics by 6%, phototherapy by 5%, and 13% received no psoriasis-related medication. Median time from index to first treatment was 0 days for topical, 6 months for non-biologic systemic, and 6 months for biologic. Of those treated, first-line therapies included topical (95%), non-biologic systemic (4%), and biologic (2%). For those with second-line treatment, non-biologic systemic (71%) and biologic (30%) therapies were more common. The most common treatment pattern was topicals only (83%), while all other patterns comprised <5% of the treatment patterns observed.Limitations: Like other observational studies, limitations to consider when interpreting results include the 6-month pre-index period of no psoriasis or the psoriasis medication claim may not perfectly select only incident user of psoriasis medications, claims-based algorithms may not accurately represent true treatment patterns, absence of over-the-counter medications data, and having no trend analyses over time or between groups.Conclusions: While the majority of patients with psoriasis initiated a pharmacological therapy, a significant portion did not have a claim for any psoriasis medication. Topical treatments are the most commonly used treatments for psoriasis. Non-biologic systemic and biologic therapies were rarely used first line, but became more common in later lines of treatment. |
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Keywords: | Psoriasis treatment patterns topicals biologics systemic treatment |
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