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

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

METHODS: A retrospective cohort study was conducted using a US claims database (Komodo Health closed claims, Jan 2015 – Dec 2022). Patients with PV were selected based on presence of: (1) ≥2 claims with PV 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 PV diagnosis, with CCI assessed during the 1-year pre-index. PV treatments were evaluated during follow-up.

RESULTS: Overall, 1770 patients with PV were identified. The median (IQR) age at index was 57 (47-67) years (18-40: 14.6%; 41-65: 58.1%; >65: 27.3%), with a predominance in females (60.8%, n=1077) and mean (SD) CCI of 1.3 (2.1). Majority of the patients (85.9%, n=1,521) were treated during the follow-up period, with corticosteroids (78.9%, n=1,397) as the most common treatment (oral corticosteroids [OCS] [61.5%, n=1,088], followed by topical corticosteroids [45%, n=804], used at least once), immunosuppressants (39%, n=691) and then rituxmab (28.4%, n=503). Majority of patients prescribed OCS have regular usage of high-dosage of steroids (60.7%, n=660, >20 mg/day for 14 consecutive days). More than half of patients treated with rituximab initiated their treatment in combination with OCS (54.5%, n=274/503), and roughly half of these patients had a high initial dosage of OCS (55.5%, n=152/274).

CONCLUSIONS: Among patients with PV, corticosteroids and immunosuppressants 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.