Greater Biologic Persistence, Adherence Achieved With Ixekizumab for Psoriasis

Ixekizumab was associated with significantly greater persistence, adherence, and time on monotherapy vs other commonly prescribed biologics in the treatment of moderate to severe psoriasis, according to study findings published today in Advances in Therapy.

Although highly effective for the management of more severe disease courses of psoriasis, use of biologics has been linked with significant drug survival issues, particularly frequent discontinuation rates and poor adherence.

“Continued adherence and persistence are key to achieving satisfactory disease control and improved quality of life. Nonadherence and nonpersistence in psoriasis treatment management lead to increased risk of recurrence and treatment failure, as well as increased health care costs,” said the study authors.

“Understanding adherence and persistence differences in psoriasis treatments in real-world settings is essential in informing decisions of patients, providers, and payers when considering biologic therapies,” they added.

Citing a lack of real-world data comparing multiple biologics on their adherence, persistence, and effectiveness as monotherapy and in combination with other therapies, researchers conducted a retrospective cohort analysis using data from the IBM MarketScan databases.

Patients registered in the administrative claims databases who newly initiated ixekizumab (n = 742; mean [SD] age, 49.3 [11.5] years), adalimumab (n = 3592; mean [SD] age, 46.2 [12.6] years), etanercept (n = 524; mean [SD] age, 48.3 [13.3] years), secukinumab (n = 1027; mean [SD] age, 48.2 [12.4] years), or ustekinumab (n = 1912; mean [SD] age, 46.7 [13.2] years) for the treatment of psoriasis between July 1, 2016, and July 1, 2018, were included.

Treatment comparisons on medication persistence, adherence, and monotherapy were based on balanced samples after inverse probability of treatment weighting (IPTW).

“At the time this study was conducted, data were insufficient to include interleukin (IL)-23 inhibitors in the analysis,” they noted.

Of the study cohort, most biologic users resided in the southern United States (46.7%-51.1%) and were covered by commercial insurance (92.7%-97.0%). A higher proportion of patients receiving ixekizumab had previous biologic therapies (50.3%) compared with those on adalimumab (9.1%), etanercept (10.9%), secukinumab (33.9%), and ustekinumab (19.7%).

Findings indicated that patients treated with ixekizumab showed statistically greater persistence than patients treated with secukinumab, adalimumab, ustekinumab, or etanercept at both 1-year follow-up and up to 3 years of follow-up (P < .001).

Adherence was also significantly greater among patients treated with ixekizumab vs adalimumab, etanercept, and ustekinumab at both 1-year follow-up and up to 3 years of follow-up (P < .001). No significant difference in adherence was observed between patients treated with ixekizumab compared with those treated with secukinumab at 1-year follow-up, but those given ixekizumab had higher adherence at 1 to 3 year follow-up (P < .05).

Furthermore, patients treated with ixekizumab exhibited longer time on monotherapy than adalimumab (P < .001), etanercept (P < .001), secukinumab (P < .05), and ustekinumab (P < .001) for both 1-year and 1 to 3 year follow-up. Follow-ups from 1 to 3 years showed concomitant medication use with ixekizumab was significantly shorter than all other biologics individually and combined.

Sensitivity analyses on persistence, adherence, and monotherapy with further model adjustments after IPTW confirmed the findings. Researchers concluded that study findings may help inform clinicians when making treatment decisions for the management of moderate to severe psoriasis in the real world.

“Further studies are needed to identify underlying factors that can have an influence on adherence and persistence such as gender, age, loss of efficacy, posology, or copayment amount," they concluded.

Reference

Leonardi C, Zhu B, Malatestinic WN, et al. Real-world biologic adherence, persistence, and monotherapy comparisons in US patients with psoriasis: Results from IBM MarketScan databases. Adv Ther. Published online May 16, 2022. doi:10.1007/s12325-022-02155-9