Resum: |
Patients with moderate-to-severe psoriasis (PsO) treated with interleukin (IL)-inhibitors may require treatment modification to achieve disease control. This study evaluated discontinuation and switching of IL-inhibitors for PsO patients in Japan. Japan Medical Data Center claims (1/2005-5/2022) were used to identify patients with PsO diagnosis preceding a first IL-inhibitor claim (index date) with ≥ 6 months of eligibility prior. Treatment switch (claim for another biologic) and discontinuation (gap in care ≥ 150% of the days' supply of the preceding prescription) were assessed up to 24 months following initiation. Censored Kaplan-Meier time-to-event analyses calculated rates, and Cox proportional hazards models estimated hazard ratios (HRs) adjusting for baseline characteristics. The study included 1481 unique patients treated with brodalumab (BRO; n = 159), guselkumab (GUS; n = 360), ixekizumab (IXE; n = 279), risankizumab (RIS; n = 327), secukinumab (SEC; n = 366), tildrakizumab (n = 40; excluded due to limited data), and ustekinumab (UST; n = 262). At 12/24 months, 25. 9%/38. 6% of patients overall had discontinued their index IL-inhibitor and 13. 5%/21. 2% had switched to another biologic. Discontinuation at 12/24 months was lowest for RIS (11. 2%/17. 4%), followed by UST (17. 9%/32. 2%), IXE (27. 0%/37. 0%), GUS (29. 8%/43. 0%), SEC (35. 6%/53. 8%), and BRO (37. 2%/47. 2%). Switching showed a similar trend: RIS (5. 7%/10. 7%), UST (11. 2%/19. 9%), SEC (14. 7%/25. 7%), IXE (14. 8%/21. 5%), GUS (16. 9%/23. 2%), and BRO (19. 7%/26. 8%). HRs of discontinuation relative to RIS were 2. 07 for UST, 2. 59 for IXE, 2. 70 for GUS, 3. 65 for BRO, and 3. 69 for SEC (all P ≤ 0. 001). HRs of switching relative to RIS were 2. 05 for IXE, 2. 45 for GUS, 2. 67 for SEC, 2. 73 for UST, and 2. 77 for BRO (all P ≤ 0. 01). Treatment modification of IL-inhibitors for PsO was commonly observed and could indicate insufficient disease control and/or incremental economic burden. Discontinuation and switching rates were lowest for RIS regardless of time point and adjustment for patient characteristics. The online version contains supplementary material available at 10. 1007/s13555-023-01064-1. |