Treatment patterns and costs for anti-TNFα biologic therapy in patients with psoriatic arthritis

Jacqueline B Palmer,Vivian Herrera,Zafer E Ozturk,Yunfeng Li,Melody Tran,Minlei Liao

doi:10.1186/s12891-016-1102-z

Abstract

BackgroundReal-world data regarding anti-tumor necrosis factor alpha (anti-TNFα) biologic therapy use in psoriatic arthritis (PsA) are limited; therefore, we described treatment patterns and costs of anti-TNFα therapy in PsA patients in the United States.MethodsPsA patients (N = 990) aged ≥18 years who initiated anti-TNFα therapy were selected from MarketScan claims databases (10/1/2009 to 9/30/2010). Number of patients on first- (n = 881), second- (n = 72), or third- or greater (n = 37) line of anti-TNFα therapy, persistence, time-to-switch or modification, pharmacy and medical costs (measured per patient per month [PPPM]) for each line of therapy were observed during the 3-year follow-up.ResultsPsA patients receiving only one line of anti-TNFα therapy remained on first-line for ~17 months while those who switched to second- or third- or greater persisted on first-line for ~11 to 12 months, respectively. Time to first-line modification was longer for patients who switched to third- or greater line therapy (7 months) than those who did not switch or switched to second-line (range, ~2 to 4 months). Time-to-switch and time to first-line modification was progressively shorter with each line of therapy for patients who received third- or greater line. PPPM medical costs were higher for patients who did not switch ($322) than those who switched to second- ($167) or third- or greater ($217) line. PPPM pharmacy costs were greater for patients with third- or greater line therapy ($2539) than those who did not switch ($1985) or switched to second-line ($2045).ConclusionWhile the majority of patients received only one line of anti-TNFα therapy, a subset of patients switched to multiple lines of therapy during the 3-year follow-up period. Persistence and therapy modifications differed between these patients and those receiving only one line. Overall medical costs were highest for patients who did not switch, and pharmacy costs increased as patients switched to each new line of therapy.

Highlights

Real-world data regarding anti-tumor necrosis factor alpha biologic therapy use in psoriatic arthritis (PsA) are limited; we described treatment patterns and costs of anti-TNFα therapy in PsA patients in the United States
In the group of PsA patients who received three or more lines of anti-TNFα biologic therapy, per patient per month (PPPM) pharmacy costs for the third- or greater line of therapy were lower than the first($2515 [$1800]) and second-line ($2947 [$1927]) therapies. In this descriptive claims-based study, treatment patterns differed among PsA patients who remained on their firstline of anti-TNFα biologic therapy compared with those who switched to additional lines of anti-TNFα biologic therapy
We found that patients who had three or more lines of therapy added a Disease-modifying antirheumatic drug (DMARD) to their first-line antiTNFα biologic therapy at a higher rate (18.9 %) compared with those who did not switch (8.4 %) or who switched to second-line therapy (11.1 %) over the 3-year follow-up period

Summary

Introduction

Real-world data regarding anti-tumor necrosis factor alpha (anti-TNFα) biologic therapy use in psoriatic arthritis (PsA) are limited; we described treatment patterns and costs of anti-TNFα therapy in PsA patients in the United States. Biologics approved and currently available for treating moderate-to-severe PsA include the anti-tumor necrosis factor α (anti-TNFα) drugs adalimumab, etanercept, golimumab, infliximab, certolizumab pegol; and the interleukin 12 (IL-12) and interleukin 23 (IL-23) inhibitor ustekinumab [18,19,20,21,22,23] These agents have been reported in numerous clinical studies as effective in managing symptoms such as dactylitis, enthesitis, and spondylitis, as well as skin and nail disease [13, 14, 17, 24,25,26,27,28]. Updated guidelines from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) have recommended specific treatments based on clinical domains of disease activity (i.e., peripheral arthritis, axial disease, enthesitis, dactylitis, skin, or nails) [25, 26, 29, 30]

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