OBJECTIVES: Secukinumab was approved in January 2015 to treat moderate-to-severe plaque psoriasis. The previous treatment of secukinumab patients has not been examined in real world. This study evaluated treatments received by patients with psoriasis prior to secukinumab initiation. METHODS: Adults with plaque psoriasis after January 2014 who initiated secukinumab 1/1/2015-4/30/2016 were selected from the MarketScan® Research Databases. Systemic (biologic and non-biologic), topical and non-pharmacological plaque psoriasis treatments utilized prior to secukinumab initiation were measured two ways. First, all treatments used in the 6 months before the first secukinumab claim (index) were flagged. Subsequently, the one prescription filled closest to index was determined, as an indicator of what treatment patients used just prior to initiating secukinumab. RESULTS: Patients initiating secukinumab (N=1,504) had a mean age of 48.6 years and were 54% male. Over the 6-months pre-index, 82.7% of patients were prescribed biologic and/or non-biologic systemic therapy. For the 59.2% of patients with ≥1biologic claims, the most common biologics were ustekinumab (22.9%), adalimumab (21.6%), and etanercept (11.8%). Non-biologic systemic agent claims were observed for 51.4% of patients, with 31.2%, 16.4%, 2.7%, and 18.6% for systemic steroids, apremilast, acitretin, and other systemic agents (methotrexate, cyclosporine), respectively. Among the 26.1% of patients with a biologic claim closest to index, the most commonly prescribed were ustekinumab (9.6%), adalimumab (9.1%), and etanercept (6.0%). About 26% of patients had claim(s) for non-biologic systemic agents closest to index, with 7.4% using apremilast; 31% had a claim for topical agents, 2.6% had photo therapy or laser treatment, 6% had multiple treatments on the same day (e.g., systemic plus topical agents), and 8.4% had no treatment. CONCLUSIONS: Some patients used secukinumab as the first-line biologic treatment, but over 80% of patients utilized systemic therapy for plaque psoriasis prior to starting secukinumab, with many having biologic exposure prior to secukinumab initiation.