Patient Preference for Dosing Frequency Based on Prior Biologic Experience

March 2017 | Volume 16 | Issue 3 | Original Article | 220 | Copyright © March 2017

Mingliang Zhang PhD,a Chureen Carter PharmD MS,a William H. Olson PhD,b Michael P. Johnson MS,c Susan K. Brenneman PT PhD,c Seina Lee PharmD MS,d Kamyar Farahi PhDe

aReal World Evidence, Janssen Scientific Affairs, Titusville, NJ bJanssen Scientific Affairs, Titusville, NJ cHealth Economics and Outcomes Research, Optum Life Sciences, Eden Prairie, MN dHealth Economics and Outcomes Research, Janssen Scientific Affairs, Horsham, PA eMedical Affairs Immunology, Janssen Scientific Affairs, Horsham, PA

Background: There is limited research exploring patient preferences regarding dosing frequency of biologic treatment of psoriasis. Methods: Patients with moderate-to-severe plaque psoriasis identified in a healthcare claims database completed a survey regarding experience with psoriasis treatments and preferred dosing frequency. Survey questions regarding preferences were posed in two ways: (1) by likelihood of choosing once per week or 2 weeks, or 12 weeks; and (2) by choosing one option among once every 1-2 or 3-4 weeks or 1-2 or 2-3 months. Data were analyzed by prior biologic history (biologic-experienced vs biologic-naïve, and with one or two specific biologics). Results: Overall, 426 patients completed the survey: 163 biologic-naïve patients and 263 biologic-experienced patients (159 had some experience with etanercept, 105 with adalimumab, and 49 with ustekinumab). Among patients who indicated experience with one or two biologics, data were available for 219 (30 with three biologics and 14 did not specify which biologic experience). The majority of biologic-naïve (68.8%) and overall biologic-experienced (69.4%) patients indicated that they were very likely to choose the least frequent dosing option of once every 12 weeks (Table 1). In contrast, fewer biologic-naïve (9.1% and 16.7%) and biologic-experienced (22.5% and 25.3%) patients indicated that they were very likely to choose the 1-week and 2-week dosing interval options, respectively. In each cohort grouped by experience with specific biologics, among those with no experience with ustekinumab, the most chosen option was 1-2 weeks. The most frequently chosen option was every 2-3 months, among patients with any experience with ustekinumab, regardless of their experience with other biologics. Conclusions: The least frequent dosing interval was preferred among biologic naïve patients and patients who had any experience with ustekinumab. Dosing interval may influence the shared decision-making process for psoriasis treatment with biologics.

J Drugs Dermatol. 2017;16(3):220-226.


The advent of biologics has improved quality of life, clinical outcomes, and productivity among patients treated for psoriasis.1,2 Furthermore, several studies have found greater adherence to biologic treatments compared to other forms of treatment, which may lead to better clinical outcomes.3 Patients receiving biologics place importance on the benefits specific to treatment administration, such as convenience, and report higher treatment satisfaction than those receiving traditional therapies.4-7 The most frequently prescribed biologic treatments include etanercept (Embrel®), adalimumab (Humira®), and ustekinumab (Stelara®). Etanercept8 has the most frequent maintenance dosing schedule of the biologic agents, requiring injections once to twice weekly. Labelled maintenance dosing for adalimumab9 is once every 2 weeks, and once every 12 weeks for ustekinumab.10

Importance of Patient Preferences

Satisfaction and adherence to a given psoriasis treatment can vary based upon a patient’s prior experience with various treatments.11,12,13,14 Comorbidities, cost, and efficacy have also been shown to in uence the choice of biologic treatment versus other treatments.4,5 Greater focus is being placed on patient-centered approaches to psoriasis treatment, including consideration of patient preferences of treatment modality5,15 and frequency of administration.16 Despite the increasing importance of patient preferences for choosing treatment options,4,12,15 data on patient preferences for dosing frequency in psoriasis are limited,7 and no prior studies have compared preferences among psoriasis patients having experience with specific biologic treatments.

Dosing Frequency Preferences by Overall Biologic Experience

Our group recently examined preferences in frequency of administration among patients experienced with or naïve to biologics.7 However, the dosing intervals (frequency) we examined were hypothetical and did not correspond to actual approved dosing intervals of biologics listed above. Lastly, we