OBJECTIVES: To compare treatment adherence and persistence among PsA patients initiating TNFi, IL-12/23i, IL-17i or tsDMARDs.

METHODS: Adults with ≥1 medical or pharmacy claim for a TNFi, IL-12/23i, IL-17i or tsDMARD during 10/1/2013–10/31/2018 were selected from IBM MarketScan^® Commercial and Medicare Supplemental Databases. Date of first claim was the index date. Patients were required to have ≥12 months pre-index and ≥12 months post-index continuous enrollment, ≥2 PsA diagnoses ≥30 days apart during this 24-month period, and a PsA diagnosis on/ prior to index date. Patients with ≥2 study medications on the same day, other biologic-indicated autoimmune conditions, contraindications, or any study medication prior to the index date were excluded. Pairwise propensity score matching was performed. Proportion of Days Covered (PDC), duration of persistence, and number of patients discontinuing index biologic (i.e., gap between fills >1.5 times maintenance days’ supply) were compared between matched cohorts.

RESULTS: Of 7,205 patients meeting identification criteria, there were 238 matched patient pairs for TNFi vs. IL-12/23i; 238 pairs for tsDMARDs vs. IL-12/23i; and 189 pairs for IL-17i vs. IL-12/23i. Patient characteristics were similar between cohorts. Duration of persistence was higher for the IL-12/23i cohort than for TNFi (269 vs 215 days, p<0.01) or tsDMARDs (269 vs 214 days, p<0.01), but comparable with IL‑17i. The IL-12/23i cohort had fewer index treatment discontinuations than the TNFi (53.4% vs 73.9%, p<0.01) or tsDMARDs (53.4% vs 71.8%, p<0.01) cohorts, but no significant difference with IL‑17i. During the 12-month follow-up period, patients initiating IL-12/23i had higher mean PDC than those on TNFi (0.64 vs 0.56, p<0.01) or tsDMARDs (0.64 vs 0.58, p=0.03), but similar to those on IL‑17i.

CONCLUSIONS: In this real-world study of PsA therapies with differing mechanisms of action, IL-12/23i demonstrated higher treatment adherence and longer persistence versus both TNFi and tsDMARDs, and comparability to IL-17i.