Jaclyn A Smith1, Brooke Wehausen1, Irma Richardson1, Yang Zhao2, Yunfeng Li2, Vivian Herrera2, Steven R Feldman1,3,4. 1. 1 Center for Dermatology Research, Departments of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 2. 3 Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. 3. 2 Center for Dermatology Research, Departments of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 4. 4 Center for Dermatology Research, Departments of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Abstract
BACKGROUND: Psoriasis treatment involves topical medications, oral medications, phototherapy, and/or biologics. The treatments used depend on a myriad of factors that change over time. OBJECTIVE: To characterise the frequency of and reasons for treatment changes in patients with moderate to severe psoriasis. METHODS: A chart review examined treatment changes at 902 visits by 116 patients seen between January 1, 2010, and June 30, 2015, for moderate to severe psoriasis and the physicians' justifications for those changes. 'Treatment change' was defined as switching between, adding, or removing medication classes or switching within the oral or biologic class. RESULTS: There were 221 visits with treatment changes identified, and a change occurred every 4.1 visits. On average, there were 1.2 treatment changes per year. Patients treated for at least 1 year averaged 1 treatment change every 16 months. The most common type of change was from one biologic to another biologic (24.9%), followed by adding a nonbiologic to a biologic (18.6%). The most common reason for switching was poor control or flare of psoriasis. Affordability was a more common problem for biologics than for nonbiologic treatments. CONCLUSIONS: Biologic treatment options provide a major improvement over older systemic treatments, but patients still undergo frequent treatment changes to help control their disease.
BACKGROUND:Psoriasis treatment involves topical medications, oral medications, phototherapy, and/or biologics. The treatments used depend on a myriad of factors that change over time. OBJECTIVE: To characterise the frequency of and reasons for treatment changes in patients with moderate to severe psoriasis. METHODS: A chart review examined treatment changes at 902 visits by 116 patients seen between January 1, 2010, and June 30, 2015, for moderate to severe psoriasis and the physicians' justifications for those changes. 'Treatment change' was defined as switching between, adding, or removing medication classes or switching within the oral or biologic class. RESULTS: There were 221 visits with treatment changes identified, and a change occurred every 4.1 visits. On average, there were 1.2 treatment changes per year. Patients treated for at least 1 year averaged 1 treatment change every 16 months. The most common type of change was from one biologic to another biologic (24.9%), followed by adding a nonbiologic to a biologic (18.6%). The most common reason for switching was poor control or flare of psoriasis. Affordability was a more common problem for biologics than for nonbiologic treatments. CONCLUSIONS: Biologic treatment options provide a major improvement over older systemic treatments, but patients still undergo frequent treatment changes to help control their disease.
Entities:
Keywords:
adalimumab; biologics; effectiveness; etanercept; health care delivery; pharmacoeconomics; ustekinumab