LIMITATIONS
The study relied on diagnostic codes and pharmacy prescriptions in claims, which are subject to data coding limitations and data entry errors. Also, treatment pattern analyses were built on the assumption that patients took medications as prescribed, ie, there was no confirmation that patients took the medications as directed. Pre-period number of unique biologics (as a proxy for treatment resistance) and pre-period obesity were measured and included in multivariate models. IPTW and multivariable modeling were employed to address observable imbalances between patient cohorts, but residual differences not captured in claims may remain. Lastly, the chosen databases are limited to only those individuals with commercial health coverage or private Medicare supplemental coverage.
CONCLUSION
In summary, compared to ADA, IXE use for the treatment of psoriasis is associated with significantly better long-term persistence on therapy, a greater adherence to treatment, and a lower risk of treatment discontinuation in real-world settings. The results of this study supplement the data derived from randomized controlled trials for IXE and ADA to provide important information on their effectiveness in routine clinical practice and will help to inform decisions by both healthcare providers and payers in their treatment selection for patients with moderate-to-severe psoriasis.
DISCLOSURES
Dr Andrew Blauvelt has served as a scientific adviser and/or
clinical study investigator for AbbVie, Abcentra, Aligos, Almirall,
Amgen, Arcutis, Arena, Aslan, Athenex, Boehringer Ingelheim,
Bristol-Myers Squibb, Dermavant, Eli Lilly and Company,
Evommune, Forte, Galderma, Incyte, Janssen, Landos, Leo,
Novartis, Pfizer, Rapt, Regeneron, Sanofi Genzyme, Sun
Pharma, and UCB Pharma. Dr. Nianwen Shi, Dr Carolyn R. Lew,
and Nicole M. Zimmerman are employees of IBM Watson Health
that was compensated by Eli Lilly and Company for conducting
this research. Dr Najwa Somani, Scott A. Kern, Dr Russel Burge,
Terri Ridenour, Dr Baojin Zhu, and Dr Mwangi Murage are fulltime
employees and stockholders of Eli Lilly and Company.
ACKNOWLEDGMENT
Authors thank Bilal Atiya, an employee of Eli Lilly and Company for providing inputs during study design and critical review and Uma Jyothi Kommoju, an employee of Eli Lilly Services India Private Limited for providing writing support.
Funding: This study was sponsored by Eli Lilly and Company, Indianapolis, IN, US.
Funding: This study was sponsored by Eli Lilly and Company, Indianapolis, IN, US.
REFERENCES
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10. Cai L, Gu J, Zheng J, et al. Efficacy and safety of adalimumab in Chinese patients with moderate-to-severe plaque psoriasis: results from a phase 3, randomized, placebo-controlled, double-blind study. J Eur Acad Dermatol Venereol. 2017;31:89–95.
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15. Blauvelt A, Lebwohl MG, Mabuchi T, et al. Long-term efficacy and safety of ixekizumab: A 5-year analysis of the UNCOVER-3 randomized controlled trial. J Am Acad Dermatol. 2020;S0190–9622(20)33053-X.
16. Menter A, Thaçi D, Wu JJ, et al. Long-term safety and effectiveness of adalimumab for moderate to severe psoriasis: Results from 7-year interim analysis of the ESPRIT registry. Dermatol Ther (Heidelb). 2017;7(3):365-381. doi:10.1007/s13555-017-0198-x
17. Blauvelt A, Shi N, Burge R, et al. Comparison of real-world treatment patterns among psoriasis patients treated with ixekizumab or adalimumab. Patient Prefer Adherence. 2020;14:517–527.
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20. Chastek B, Fox KM, Watson C, et al. Psoriasis treatment patterns with etanercept and adalimumab in a United States health plan population. J Dermatolog Treat. 2013;24:25–33.
21. Doshi JA, Takeshita J, Pinto L, et al. Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population. J Am Acad Dermatol. 2016;74:1057–1065.e4.
22. Feldman SR, Zhang J, Martinez DJ, et al. Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderateto- severe plaque psoriasis by metabolic condition status. J Dermatolog Treat. 2021;32:203–211.
23. No DJ, Inkeles MS, Amin M, Wu JJ. Drug survival of biologic treatments in psoriasis: a systematic review. J Dermatolog Treat. 2018;29:460–466.
24. van den Reek JMPA, Kievit W, Gniadecki R, et al. Drug survival studies in dermatology: Principles, purposes, and pitfalls. J Invest Dermatol. 2015;135:1–5.
25. Armstrong AW, Foster SA, Comer BS, et al. Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization. BMC Dermatol. 2018;18:4.
26. Murage MJ, Gilligan AM, Tran O, et al. Ixekizumab treatment patterns and healthcare utilization and costs for patients with psoriasis. J Dermatolog Treat. 2021;32:56–63.
2. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80:1029–1072.
3. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58:826–850.
4. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60:643–659.
5. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy (published correction appears in J Am Acad Dermatol. 2021;84:586). J Am Acad Dermatol. 2010;62:114–135.
6. Belinchón I, Rivera R, Blanch C, et al. Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: a systematic review of the literature. Patient Prefer Adherence. 2016;10:2357–2367.
7. Rønholt K, Iversen L. Old and new biological therapies for psoriasis. Int J Mol Sci. 2017;18:2297.
8. Alwawi EA, Mehlis SL, Gordon KB. Treating psoriasis with adalimumab. Ther Clin Risk Manag. 2008;4:345–351.
9. Asahina A, Nakagawa H, Etoh T, et al. Adalimumab in Japanese patients with moderate to severe chronic plaque psoriasis: efficacy and safety results from a phase II/III randomized controlled study. J Dermatol. 2010;37299–310.
10. Cai L, Gu J, Zheng J, et al. Efficacy and safety of adalimumab in Chinese patients with moderate-to-severe plaque psoriasis: results from a phase 3, randomized, placebo-controlled, double-blind study. J Eur Acad Dermatol Venereol. 2017;31:89–95.
11. Griffiths CE, Reich K, Lebwohl M, et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet. 2015;386:541–551.
12. Leonardi C, Maari C, Philipp S, et al. Maintenance of skin clearance with ixekizumab treatment of psoriasis: three-year results from the UNCOVER-3 study. J Am Acad Dermatol. 2018;79:824–830.e2.
13. Reich K, Pinter A, Lacour JP, et al. Comparison of ixekizumab with ustekinumab in moderate-to-severe psoriasis: 24-week results from IXORA-S, a phase III study. Br J Dermatol. 2017;177:1014–1023.
14. Saurat JH, Stingl G, Dubertret L, et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol. 2008;158:558–566.
15. Blauvelt A, Lebwohl MG, Mabuchi T, et al. Long-term efficacy and safety of ixekizumab: A 5-year analysis of the UNCOVER-3 randomized controlled trial. J Am Acad Dermatol. 2020;S0190–9622(20)33053-X.
16. Menter A, Thaçi D, Wu JJ, et al. Long-term safety and effectiveness of adalimumab for moderate to severe psoriasis: Results from 7-year interim analysis of the ESPRIT registry. Dermatol Ther (Heidelb). 2017;7(3):365-381. doi:10.1007/s13555-017-0198-x
17. Blauvelt A, Shi N, Burge R, et al. Comparison of real-world treatment patterns among psoriasis patients treated with ixekizumab or adalimumab. Patient Prefer Adherence. 2020;14:517–527.
18. Humira [package insert]. North Chicago, IL: Abbvie Inc.; 2002.
19. Taltz [package insert]. Indianapolis, USA: Eli Lilly and Company; 2016.
20. Chastek B, Fox KM, Watson C, et al. Psoriasis treatment patterns with etanercept and adalimumab in a United States health plan population. J Dermatolog Treat. 2013;24:25–33.
21. Doshi JA, Takeshita J, Pinto L, et al. Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population. J Am Acad Dermatol. 2016;74:1057–1065.e4.
22. Feldman SR, Zhang J, Martinez DJ, et al. Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderateto- severe plaque psoriasis by metabolic condition status. J Dermatolog Treat. 2021;32:203–211.
23. No DJ, Inkeles MS, Amin M, Wu JJ. Drug survival of biologic treatments in psoriasis: a systematic review. J Dermatolog Treat. 2018;29:460–466.
24. van den Reek JMPA, Kievit W, Gniadecki R, et al. Drug survival studies in dermatology: Principles, purposes, and pitfalls. J Invest Dermatol. 2015;135:1–5.
25. Armstrong AW, Foster SA, Comer BS, et al. Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization. BMC Dermatol. 2018;18:4.
26. Murage MJ, Gilligan AM, Tran O, et al. Ixekizumab treatment patterns and healthcare utilization and costs for patients with psoriasis. J Dermatolog Treat. 2021;32:56–63.
AUTHOR CORRESPONDENCE
Mwangi J. Murage PhD MPH murage_mwangi_james@lilly.com
