patients still received at least 1 new prescription for a topical medication (data not shown).
There was also concomitant use of phototherapy and prescriptions written for oral systemic therapies in patients with ongoing prescriptions for biologics. Less than 5% of patients had at least 1 phototherapy procedure during the time of ongoing biologic prescriptions (Table 5). Of the patients with at least 1 phototherapy encounter, the median number of treatments was 7 in patients on secukinumab, 16 in patients on adalimumab and 18 in patients who were prescribed etanercept, infliximab, and ustekinumab. For oral systemic therapies, methotrexate was the most commonly prescribed concomitant oral therapy. The highest percentage of patients receiving at least 1 prescription for methotrexate was seen in patients receiving prescriptions for infliximab (48.7%; Table 5). Patients prescribed secukinumab and ustekinumab were much less likely to be prescribed methotrexate, with 15.2% and 14.3% of patients receiving prescriptions for methotrexate, respectively. Concomitant prescriptions for acitretin, apremilast and cyclosporine, were written for less than 5% of patient on any biologic therapy. The percentage of people who received concomitant prescriptions for oral systemic therapies were similar when excluding prescription written within the first 3 months of the first biologic prescription, with the exception of for people who received prescriptions for etanercept (data not shown).
There was also concomitant use of phototherapy and prescriptions written for oral systemic therapies in patients with ongoing prescriptions for biologics. Less than 5% of patients had at least 1 phototherapy procedure during the time of ongoing biologic prescriptions (Table 5). Of the patients with at least 1 phototherapy encounter, the median number of treatments was 7 in patients on secukinumab, 16 in patients on adalimumab and 18 in patients who were prescribed etanercept, infliximab, and ustekinumab. For oral systemic therapies, methotrexate was the most commonly prescribed concomitant oral therapy. The highest percentage of patients receiving at least 1 prescription for methotrexate was seen in patients receiving prescriptions for infliximab (48.7%; Table 5). Patients prescribed secukinumab and ustekinumab were much less likely to be prescribed methotrexate, with 15.2% and 14.3% of patients receiving prescriptions for methotrexate, respectively. Concomitant prescriptions for acitretin, apremilast and cyclosporine, were written for less than 5% of patient on any biologic therapy. The percentage of people who received concomitant prescriptions for oral systemic therapies were similar when excluding prescription written within the first 3 months of the first biologic prescription, with the exception of for people who received prescriptions for etanercept (data not shown).
CONCLUSIONS
In conclusion, this analysis of prescriptions written from electronic health records data from the United States found that up to 50% of patients that received a prescription for a biologic medication did not receive a second prescription for the same medication. The median time between first and last prescriptions was between 3.3 and 7.0 months, depending on the biologic prescribed. In a subset of patients who received continuous prescriptions for the same biologic medication for more than 12 months, more than 50% continued to receive prescriptions of topical therapies, most commonly topical steroids. We also found that methotrexate was commonly prescribed concurrently with biologics, while other oral systemic therapies (acitretin, apremilast, cyclosporine) and phototherapy were not commonly prescribed concurrently.
Previous research examining drug survival has focused on data from patient registries and adjudicated insurance claims datasets. In the PSOLAR prospective patient registry, median drug survival times of 2 years or more was reported for first-line biologic medications.3 Analysis of private insurance claims data from the United States has shown only about 50-75% of patients are still taking the index biologic 12 months after starting.4,5 In the Medicare population, this number drops to about 50% of patients at 12 months.1 The drug survival in our analysis was on the lower end of what has been previously reported, with the median time between first and last prescription for all the biologic therapies of less than 1 year.
Exploring drug survival by examining prescriptions written, instead of insurance claims or prospective registry data, highlights a different perspective, capturing the full experience from the point at which a prescription is written. Our results highlight
Previous research examining drug survival has focused on data from patient registries and adjudicated insurance claims datasets. In the PSOLAR prospective patient registry, median drug survival times of 2 years or more was reported for first-line biologic medications.3 Analysis of private insurance claims data from the United States has shown only about 50-75% of patients are still taking the index biologic 12 months after starting.4,5 In the Medicare population, this number drops to about 50% of patients at 12 months.1 The drug survival in our analysis was on the lower end of what has been previously reported, with the median time between first and last prescription for all the biologic therapies of less than 1 year.
Exploring drug survival by examining prescriptions written, instead of insurance claims or prospective registry data, highlights a different perspective, capturing the full experience from the point at which a prescription is written. Our results highlight
