OBJECTIVES:

This study assessed Biologic and Targeted Synthetic Disease-Modifying Anti‑Rheumatic Drugs (b/tsDMARDs) persistence, factors associated with non-persistence, and dosing patterns in patients with psoriatic arthritis (PsA).

METHODS:

Using US commercial claims database MarketScan, adult patients with PsA initiating new b/tsDMARDs 1Jan2016―30Sep2021 were followed for 12 months. Persistence of index PsA treatment was estimated using Kaplan-Maier curves. Cox regression models were applied to test associations between patient characteristics and non-persistence. Dosing of secukinumab (SEC) was reported considering PsA-only and co-occurring psoriasis (PsA+PSO) patients due to different prescribing recommendations.

RESULTS:

Among 5,325 PsA patients (mean age 50.3 years) initiating b/tsDMARD, 41% were male and 85.4% b/tsDMARD-naïve. During follow-up, 1,707 patients discontinued treatment and 521 switched to another b/tsDMARD. Drug persistence probabilities at 12 months (for most frequently prescribed [>100 patients] b/tsDMARDs) were 62%, 55%, 52%, and 47% for interleukin (IL)-17A (N=662), IL-12/23 (N=294), tumor necrosis factor (N=2,946), and phosphodiesterase-4 (N=1,323) inhibitors, respectively. Similar persistence was observed among b/tsDMARD-naïve and b/tsDMARD‑experienced patients. Non-persistence rate was higher in females and patients with multiple baseline comorbidities.

Up to 56% of 518 patients initiating SEC (with dose records available) were prescribed 300mg as starting dose. Among 101 PsA-only patients, 45 (45%) started SEC at 150mg, while during follow up 25% of patients remained on 150mg and 20% escalated to 300mg. Among 417 PsA+PSO patients, 255 (61%) started SEC at 300mg and during follow up 56% patients were maintained on 300mg, while 9% escalated to 300mg.

CONCLUSIONS:

This real-world data indicated that among US PsA patients initiating b/tsDMARD, overall persistence probability was suboptimal with approximately half of the patients discontinuing or switching treatment within 12 months, regardless of previous exposure to biologics. b/tsDMARD usage and dosage appeared to be affected by specific baseline characteristics, which may identify patients who require additional management.