Real-World Treatment Patterns in Adults with Pemphigus Foliaceus in the United States

OBJECTIVES: To evaluate treatment patterns in patients with pemphigus foliaceus (PF) in the United States.

METHODS: A retrospective cohort study was conducted using a US claims databaset (Komodo Health closed claims, Jan 2015 – Dec 2022). Patients with PF were selected based on the presence of: (1) ≥2 claims with PF diagnosis ≥30-≤365 days apart, with the first claim captured between Jan 2019 and Dec 2021 (index date), (2) no other types of pemphigus in the 1- year post-index date and (3) continuous enrollment ±1 year pre- and post-index date (follow-up). Baseline charateristics were evaluated on first PF diagnosis, with CCI assessed during the 1-year pre-index. PF treatments were evaluated during follow-up.

RESULTS: Overall, 345 patients with PF were identified. The median (IQR) age at index was 59 (47-68) years (18-40: 15.9%; 41-65: 55.7%; >65: 28.4%), with predominance in females (56.5%, n=195) and mean (SD) CCI of 1.2 (2.0). Majority of the patients (93.3%, n=322) were treated during the follow-up period, with corticosteroids (84.9%, n=293) as the most common treatment (topical steroids [69%, n=238] followed by oral corticosteroids (OCS) [54.8%, n=189], used at least once). A sizeable proportion of patients (22.3%, n=77) also used rituxmab at least once during the follow-up period. Majority of patients prescribed OCS have regular usage of high-dosage of steroids (67.7%, n=128, >20 mg/day for 14 consecutive days). Approximately half of patients treated with rituximab initiated their treatement in combination with OCS (44.2%, n=34/77), and roughly two-thirds of these patients had a high initial dosage of OCS (64.7%, n=22/34).

CONCLUSIONS: Among patients with PF, corticosteroids were the most common treatments in the 1-year post-diagnosis. As a substantial proportion of patients used a high-dose OCS, future studies should be conducted to better understand the impact of patients facing high treatment burdens.