OBJECTIVES: Apremilast was approved in 2014 to treat adult patients with active psoriatic arthritis (PsA). Few studies have evaluated persistence and adherence in a real-world setting. This study compared treatment persistence and adherence over 12 months among biologic-naive and biologic-experienced patients with active PsA who initiated treatment with apremilast or a biologic.

METHODS: Adult patients with PsA were selected if they had initiated apremilast or biologic therapy between January 1, 2014, and December 31, 2015, and had 12 months of pre- and post-index continuous enrollment in the Optum Clinformatics™ claims database. Patients initiating apremilast were 1:2 propensity score matched to patients initiating biologics. Treatment persistence was defined as index treatment without a >60-day gap or a switch to a different PsA treatment during the 12-month post-index period. Patients were adherent if their medication possession ratio (MPR) was ≥80% while persistent on the index treatment. T-test and chi-square statistics were used to evaluate the differences between the 2 cohorts for continuous and categorical variables, respectively.

RESULTS: A total of 193 PsA patients initiating apremilast were matched to 381 PsA patients initiating a biologic. Patient characteristics were similar between cohorts (mean age, 53 years in both cohorts; female, 59% [apremilast] vs 53% [biologic]; and mean Charlson score, 0.9 in both cohorts). Treatment persistence at 12 months was similar for PsA patients initiating apremilast vs those initiating biologics (38% vs 39%; P=0.765). The non-persistent patients initiating apremilast had higher switch rates than patients initiating biologics (47% vs 35%; P=0.026). Persistence-based MPRs were similar for patients initiating apremilast vs patients initiating biologics (92% vs 91%; P=0.096), and adherence rates were 87% and 83% (P=0.235), respectively.

CONCLUSIONS: Treatment persistence and adherence at 12 months were similar for patients with PsA initiating apremilast or biologics in a large US administrative claims database.