Jalpa A Doshi1, Junko Takeshita2, Lionel Pinto3, Penxiang Li4, Xinyan Yu4, Preethi Rao5, Hema N Viswanathan3, Joel M Gelfand2. 1. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: jdoshi@mail.med.upenn.edu. 2. Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 3. Amgen Inc, Thousand Oaks, California. 4. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 5. Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Health Care Management and Economics, The Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population. OBJECTIVE: We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab. METHODS: We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting. RESULTS: We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic. LIMITATIONS: Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data. CONCLUSION: Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.
BACKGROUND: Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population. OBJECTIVE: We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab. METHODS: We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting. RESULTS: We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic. LIMITATIONS: Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data. CONCLUSION: Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.
Authors: Ivan S Grozdev; Abby S Van Voorhees; Alice B Gottlieb; Sylvia Hsu; Mark G Lebwohl; Bruce F Bebo; Neil J Korman Journal: J Am Acad Dermatol Date: 2011-04-15 Impact factor: 11.527
Authors: Howa Yeung; Junko Takeshita; Nehal N Mehta; Stephen E Kimmel; Alexis Ogdie; David J Margolis; Daniel B Shin; Rosemary Attor; Andrea B Troxel; Joel M Gelfand Journal: JAMA Dermatol Date: 2013-10 Impact factor: 10.282
Authors: Megan H. Noe; Daniel B. Shin; Jalpa A. Doshi; David J. Margolis; Joel M. Gelfand Journal: J Drugs Dermatol Date: 2019-08-01 Impact factor: 2.114
Authors: Xintong Li; Kathleen M Andersen; Hsien-Yen Chang; Jeffrey R Curtis; G Caleb Alexander Journal: Ann Rheum Dis Date: 2019-10-31 Impact factor: 19.103
Authors: Shail M Govani; Mohamed Noureldin; Peter D R Higgins; Michele Heisler; Sameer D Saini; Ryan W Stidham; Jennifer F Waljee; Akbar K Waljee Journal: Am J Gastroenterol Date: 2017-12-12 Impact factor: 10.864
Authors: Andrew Blauvelt; Nianwen Shi; Russel Burge; William N Malatestinic; Chen-Yen Lin; Carolyn R Lew; Nicole M Zimmerman; Orin M Goldblum; Baojin Zhu; Mwangi J Murage Journal: Patient Prefer Adherence Date: 2020-03-09 Impact factor: 2.711