OBJECTIVES: Apremilast was approved in 2014 to treat moderate to severe plaque psoriasis in patients who are candidates for phototherapy or systemic therapy. 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 psoriasis who initiated treatment with apremilast or a biologic.

METHODS: Adult patients with psoriasis 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 psoriasis 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 408 psoriasis patients initiating apremilast were matched to 810 psoriasis patients initiating a biologic. Patient characteristics were similar between cohorts (mean age, 50 years in both cohorts; female, 46% [apremilast] vs 48% [biologic]; and mean Charlson score, 0.6 in both cohorts). Treatment persistence at 12 months was similar for psoriasis patients initiating apremilast vs those initiating biologics (30.6% vs 33.8%; P=0.263). The non-persistent patients initiating apremilast or biologics had similar switch rates (29% vs 26%; P=0.356). Persistence-based MPRs were similar for patients initiating apremilast vs patients initiating biologics (91% vs 91%; P=0.972), and adherence rates were 79% and 83% (P=0.121), respectively.

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