Prescribing Patterns Associated With Biologic Therapies for Psoriasis from a United States Medical Records Database

August 2019 | Volume 18 | Issue 8 | Original Article | 745 | Copyright © August 2019

Megan H. Noe MD MPH MSCE, Daniel B. Shin PhD, Jalpa A. Doshi PhD, David J. Margolis MD PhD, Joel M. Gelfand MD MSCE

University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Abstract
Introduction: Selecting a systemic therapy for patients with psoriasis is a complex process, based on a variety of factors including psoriasis severity, comorbid health conditions, access to care, and both patient and provider preference. The objective of this study was to use data from electronic health records to understand prescribing patterns associated with biologic therapies for psoriasis and utilization of concomitant non-biologic psoriasis therapies in patients on biologics.

Methods: A retrospective cohort study was performed using OptumInSight’s electronic health records database. Patients were classified as having psoriasis if they had 2 diagnosis codes for psoriasis or 1 diagnosis for psoriasis and a subsequent prescription for a systemic psoriasis therapy or phototherapy on a separate day. Only patients with at least 1 prescription for a biologic medication were included. The time between the first and last prescription in each prescription episode was calculated; at least 1 prescription every 180 days was required to be considered continuous therapy. We also identified a subgroup of patients with prescription episodes of at least 12 months duration in which to evaluate concomitant use of topical medications, phototherapy, and other systemic agents in patients receiving prescriptions for biologics.

Results: There were 34,714 eligible psoriasis patients. The median time between first and last prescriptions was 3.3 - 7.0 months, depending on the drug and up to 50% of patients that received a prescription for a biologic medication did not receive a second prescription for the same medication. In a subset of patients with prescription episodes of at least 12 months duration, more than 50% continued to receive prescriptions for topical therapies, most commonly topical steroids.

Discussion: Recognition of prescribing patterns associated with biologic medications for psoriasis is important to understand healthcare utilization and improve health systems practices for patients and providers.

J Drugs Dermatol. 2019;18(8):745-750.

INTRODUCTION

Selecting a systemic therapy for a patient with psoriasis is a complex process, based on a variety of factors including psoriasis severity, comorbid health conditions, access to care, and both patient and provider preference. Recognition of prescription patterns associated with biologic medications for psoriasis is important to understand healthcare utilization. Much of the previous research regarding the utilization of biologics in the United States comes from analysis of prospective patient registries and adjudicated insurance claims datasets.1-5 An insurance claim is only generated when a prescription is submitted by the patient to the pharmacy, approved by the insurer, and, if necessary, paid for by the patient. There is ample evidence, however, that biologic prescriptions are often subject to more restrictive coverage policies and/or high out-of-pocket costs leading to the prescription’s rejection by the insurer or abandonment by the patient.6,7 Utilizing electronic health records (EHR) data to examine prescriptions written is a different way to understand drug utilization that captures more of the treatment selection process and is important to understand the full selection process that occurs from the time the first prescription is written until a patient actually starts a medication. Biologic therapies are highly efficacious treatments for psoriasis, but most treatment guidelines, recommend concomitant use of adjunct therapies as necessary in those with continued disease activity.8-10 Little has been reported about the actual utilization of concomitant psoriasis therapies including topical medications, phototherapy, and other systemic agents in patients on biologics. Analysis of concomitant prescriptions using claims data would only capture medications picked up from the pharmacy, but electronic health records captures all prescriptions written, signifying any time a provider thought adjuvant therapies were necessary, regardless of whether a patient decided to start the medication. The objective of this study was to utilize data from EHR to understand prescribing patterns associated with biologic therapies for psoriasis and investigate utilization of concomitant psoriasis therapies, including topical medications, phototherapy, and other systemic agents in patients on biologics in the United States. Evaluation of psoriasis medications through EHR will provide a different perspective on drug utilization, increasing the overall understanding of healthcare utilization in psoriasis.