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Metabolic Conditions Increase Likelihood of Switching or Discontinuing Biologic Treatment

Patients with psoriasis and comorbid metabolic conditions were more likely to switch or discontinue treatment compared with those without metabolic conditions, according to a recent study.

In the study, researchers analyzed data of 7773 adult patients with 1 or more prescription for secukinumab (Cosentyx), adalimumab (Humira), ustekinumab (Stelara), etanercept (Enbrel), or apremilast (Otezla) between January 1, 2015 and August 31, 2018. The researchers divided patients into treatment cohorts and stratified them by metabolic condition status. They compared treatment patterns, such as adherence, non-persistence, switching, discontinuation, use of combination therapy, and re-initiation, and health care costs between those with and those without metabolic conditions.

About 47.5% to 56.7% of patients had a metabolic condition, the researchers said. Aside from the apremilast group, patients with metabolic conditions had higher discontinuation and switching compared with those without metabolic conditions.
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Discontinuation among patients with metabolic conditions occurred in 50.6%, 53.9%, 41.9%, and 42.8% in secukinumab, adalimumab, ustekinumab, and etanercept groups, respectively, compared with 43.7%, 48.7%, 35.1%, and 41.2% in those without metabolic conditions. In the apremilast group, discontinuation was reported in 43.1% and 46.1% of patients with and without metabolic conditions.

Among patients with metabolic conditions, switching occurred in 48.1% of those treated with secukinumab, 47.8% of those treated with adalimumab, 34.5% of those treated with ustekinumab, 53.6% of those treated with etanercept compared with 41.2%, 41.9%, 25.3%, and 51.5% of those without metabolic conditions. Switching among patients on apremilast occurred in 45.8% and 44.6% of those with and without metabolic conditions, respectively.

In addition, the researchers found patients with metabolic conditions had significantly higher health care costs.

“Many psoriasis patients initiating biologics or apremilast had metabolic conditions. These patients had higher discontinuation and switching, and significantly higher healthcare costs,” the researchers concluded.


Feldman SR, Zhang J, Martinez DJ, et al. Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status [published online November 26, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1698699

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