Real-world biologic treatment patterns and healthcare resource utilization in psoriasis patients using an insurance claims database in Japan

Figures & data

Figure 1. Study design.

JMDC, Japanese Medical Data Center

Figure 2. Patient flow.

ICD-10, International Classification of Diseases, 10^th revision; TEs, treatment episodes

Note: Treatment episodes is defined as first dispensation of the treatment of interest to the last dispensation of treatment of interest.

Figure 3. Comorbid conditions in patients diagnosed with psoriasis.

Figure 4. Concomitant medications used in patients diagnosed with psoriasis.

Table 1. Baseline demographics and characteristics of psoriasis patients who received biologic treatment.

Patient characteristics*		Overall	TNFα	IL-17	IL-12/23	IL-23
Age	N	1,614	624	480	324	186
	Mean (SD)	47.4 (11.3)	47.8 (10.9)	46.7 (11.8)	47.1 (11.1)	48.2 (11.4)
	Median	48.4	48.5	48.4	47.1	49.8
	Q1–Q3	40.6–55.5	41.3–56.1	39.1–55.3	40.6–54.3	40.3–56.0
	Min–Max	18.1–74.2	18.2–73.7	18.1–73.9	20.6–74.2	19.8–74.0
Female	N (%)	443 (27.4)	191 (30.6)	133 (27.7)	74 (22.8)	45 (24.2)
Male	N (%)	1171 (72.5)	433 (69.4)	347 (72.3)	250 (77.2)	141 (75.8)
Psoriasis only	N (%)	996 (61.7)	299 (47.9)	295 (61.5)	260 (80.2)	142 (76.3)
Psoriasis & psoriatic arthritis	N (%)	618 (38.3)	325 (52.1)	185 (38.5)	64 (19.8)	44 (23.7)
Charlson Comorbidity index	Mean (SD)	0.85 (1.38)	0.95 (1.42)	0.85 (1.45)	0.62 (1.14)	0.92 (1.44)
	Median	0	0	0	0	1

IL, interleukin; SD, standard deviation; TNF, tumor necrosis factor.

*Different class of treatment cohorts were stratified by the 1st biologics line of treatment.

Figure 5. Treatment sequences among classes of biologics for psoriasis.

IL, interleukin; TNFα, tumor necrosis factor

Table 2. Time to switch and resumption of biologics in months.

	Overall	Bio-naïve	Bio-experienced
Total N = 1,614
Time to switch to a different treatment
Patients, N*	305	282	88
Switch events, N	393	282	111
Mean (SD)	12.8 (10.7)	14.1 (11.7)	9.4 (7.0)
Median (months)	9.4	10.9	8.1
Q1–Q3	4.6–16.8	5.1–19.8	3.9–13.6
Min–Max	0.4–54.5	0.5–54.5	0.4–40.7
Time to resumption of the same treatment
Patients, N*	213	184	94
Resumption events, N	314	184	130
Mean (SD)	12.0 (7.6)	14.0 (8.0)	9.2 (6.0)
Median (months)	9.7	12.6	7.5
Q1–Q3	5.8–16.6	7.3–19.0	4.8–11.3
Min– Max	3.5–39.8	3.5–39.1	3.5–39.8

*Groups are not mutually exclusive when considering the number of patients. A given patient can have multiple events (whether switch or resumption) and therefore be counted in multiple groups.

Table 3. Treatment adherence as represented by medication possession ratio (MPR).

Overall Adherence	Overall	Bio-naïve	Bio-experienced	Certolizumab pegol	Secukinumab	Adalimumab	Brodalumab	Infliximab	Risankizumab	Ustekinumab	Ixekizumab	Guselkumab
Number of treatment episodes, N	2698	1348	1350	41	419	753	237	233	177	372	265	201
Mean %	80.1	82.8	77.4	67.5	82.6	54.5	56.3	105.7	119.6	100.1	80.1	100.1
Median %	93.3	92.8	94.1	53.8	69.6	38.9	37.5	100.0	112.5	98.7	72.7	101.1

Note: Optimal adherence is considered as nearest to 100%.

Table 4. Cross-sectional evaluation of HCRU and related direct medical costs in 2020.

	Overall patients (N = 660)	Bio-naïve (n = 374)	Bio-experience (n = 286)
Outpatient visits
Total visit	5,841	3,362	2,479
Rate per patient-year	9.05	9.34	8.69
Inpatient admission visits
Total visit	60	28	32
Rate per patient-year	0.09	0.08	0.11
Length of stay
Total days spent in Hospital	474	173	301
Rate per patient-year	0.73	0.48	1.06
Psoriasis-related phototherapy
Total event	321	272	49
Rate per patient-year	0.50	0.76	0.17
Direct medical cost
Total cost (JPY)	6,588,383,387	3,370,539,751	3,217,843,636
Rate per patient-year (JPY)	10,212,986	9,364,392	11,284,062

HCRU, healthcare resource utilization; JPY, Japanese yen.

Data availability

The data that support the findings of this study are available from JMDC Inc. Restrictions apply to the availability of these data, which were used under license for this study. Data could be available on request with the permission of JMDC Inc.