OBJECTIVES: Previous studies have shown a positive association between treatment satisfaction and persistence. There is a paucity of real-world data regarding persistence associated with the use of apremilast, conventional systemic therapies and biologics in the treatment of psoriasis. The objective of this study was to compare treatment persistence among psoriasis (PSO) patients initiating apremilast, conventional systemic therapies or subcutaneous biologic therapy in US claims data.

METHODS: This descriptive, observational, retrospective cohort study was conducted using MarketScan Commercial and Medicare Supplemental Databases (2013-2016). Adults with ≥2 diagnosis codes for psoriasis (ICD-9:696.1; ICD-10:40.0) who initiated apremilast, other oral therapy, or biologic therapy were selected. The first prescription date was defined as the index date and patients were required to be continuously enrolled for ≥12 months pre- and ≥12 months post-index. Persistence was measured as the time from initiation to discontinuation, defined as the end of days’ supply prior to at least a 60-day gap without medication. At 12 months post-index the percentage of patients persisting on drug was assessed.

RESULTS: In total, 972 patients initiating apremilast, 2,934 patients initiating other oral therapy, and 2,303 initiating biologic therapy met the inclusion criteria and had similar baseline characteristics. Mean enrollment follow-up time post-index was 499 days for apremilast, 591 days for other oral therapy, and 590 for biologic therapy. At 12 months post-index, persistence to initiated drug was 37.3% for apremilast, 20.4% for other oral therapy (p<0.001 vs apremilast), and 38.2% for biologic therapy (p=0.600 vs apremilast). Further sub-analyses showed a statistically significant, higher persistence for patients on apremilast compared to etanercept, (apremilast: 37.3% vs etanercept: 31.9%, p=0.022), while the persistence rates for patients on apremilast and adalimumab were similar (adalimumab: 40.2% vs apremilast: 37.3%, p=0.123).

CONCLUSIONS: Patient persistence on apremilast therapy is significantly higher compared to conventional systemic therapies and not significantly different compared to biologic therapies.