Treatment adherence and persistence of five commonly prescribed medications for moderate to severe psoriasis in a U.S. commercially insured population

Abstract

Objective

To evaluate medication discontinuation, persistence, and adherence of moderate to severe psoriasis patients treated with adalimumab, apremilast, etanercept, secukinumab, and ustekinumab.

Methods

Adult patients diagnosed with psoriasis and ≥1 psoriasis pharmacy or medical claim of any of the five psoriasis medications (index date) and continuous insurance enrollment were included from the Optum Clinformatics database during the intake period (7/1/2014–9/30/2017). Medication discontinuation, persistence, medication possession ratio (MPR), and proportion of days covered (PDC) were evaluated during a 12-month post-index follow-up period, using three gap definitions.

Results

Among the study population (n = 8524), 34.4% initiated adalimumab, 25.7% apremilast, 9.0% etanercept, 7.1% secukinumab, and 23.7% ustekinumab. Mean age ranged from 48.7 to 52.2 years. For all three gap definitions, discontinuation was lowest and persistence greatest among ustekinumab treated patients (48.4% and 59.8%, respectively using the default definition). A greater proportion of ustekinumab patients had an MPR ≥80% (81.8%) than adalimumab (67.9%), apremilast (54.9%), etanercept (56.4%), and secukinumab (68.0%) patients. Also, 50.6% of ustekinumab patients had a PDC ≥80% versus 35.6%, 23.9%, 19.5%, and 41.7% of adalimumab, apremilast, etanercept, and secukinumab patients, respectively.

Conclusions

Although heterogeneity across cohorts may explain some medication utilization differences, ustekinumab was associated with lower discontinuation and greater persistence and adherence.

Keywords:

• Psoriasis
• psoriasis medications
• discontinuation
• persistence
• adherence

Acknowledgments

The authors would like to thank Jay Lin and Melissa Lingohr-Smith of Novosys Health for their writing contribution to this manuscript and acknowledge that this contribution was supported by Janssen. The authors wish to thank Kamal Kant Mangla (Mu Sigma, LLC) for programming support.

Disclosure statement

Bingcao Wu, Erik Muser, Amanda Teeple, and Christopher D Pericone are employees of Janssen. Steven R Feldman is a paid consultant of Janssen.

Additional information

Funding

This work was supported by Janssen Scientific Affairs, LLC.