BIOLOGIC EXPERIENCE AND SYSTEMIC MEDICATION USE AMONG COMMERCIALLY INSURED PSORIASIS PATIENTS RECEIVING USTEKINUMAB

Purpose: Ustekinumab (UST) was FDA-approved for use in moderate to severe plaque psoriasis (PsO) on September 25, 2009. Historical biologic use and evidence of concomitant systemic medications may be indicators of PsO disease severity from a payer perspective. Total annual treatment, monitoring, and office visit costs associated with systemic medications may range from $1,197 (methotrexate) to $17,613 (acitretin).¹ No real-world observational data have been published, thus far, examining biologic experience or concomitant systemic medication use of PsO patients receiving UST. The purpose of this study was to describe the biologic experience and concomitant systemic medication use of PsO patients initiating UST.

Method: IMS LifeLink™ database was utilized to analyze patients with an index medical/pharmacy claim of UST therapy initiated 09/25/2009-12/31/2009. Inclusion criteria: patients aged ≥ 18 years at index, ≥ 1 PsO diagnosis code, and ≥ 360/180 days pre-/post-index continuous enrollment. Systemic medications included acitretin, azathioprine, cyclosporine, mercaptopurine, methotrexate, mycophenolate mofetil, and sulfasalazine.

Result: A total of 112 PsO patients receiving UST were identified from LifeLink™.  Mean (SD) age was 46 (11) years; 56% were male.  The majority (68%; n=76) of patients had pre-index biologic experience. Among the biologic-experienced, 41% received adalimumab, 38% received etanercept, 24% received infliximab, 17% received efalizumab, and 8% received alefacept pre-index.  Prior to UST, 49% (n=37) of biologic-experienced patients received biologic and systemic medications. After initiating UST, 12% of UST patients received concomitant systemic medications. Methotrexate, cyclosporine, and acitretin were the only systemic medications observed in the pre-or post-UST period.

Conclusion: The majority of patients receiving UST were biologic-experienced.  Systemic medication use was evident in nearly half of all biologic-experienced PsO patients prior to UST, but only in approximately 1 in 10 patients after initiating UST. Further research is necessary in a larger sample size, while controlling for baseline clinical and economic factors. Additionally, the safety of concomitant use of ustekinumab with immunosuppressants has not been evaluated. Lastly, an evaluation of the impact of biologic experience on UST dosing and the economic impact of UST on use of other PsO medications is warranted. ¹ Beyer V and Wolverton SE. Recent Trends in Systemic Psoriasis Treatment Costs. Arch Dermatol. 2010;146(1):46-54.