Adherence, persistence and treatment switching in psoriasis

Abstract

Aim: This study aims to investigate drug utilization patterns in the treatment of psoriasis (PsO) from 1 to 5 years in a real-life setting with Adalimumab (Ada), Etanercept (Eta), Ustekinumab (Ust), Golimumab (Gol), Ixekizumab (Ixe), Secukinumab (Sec) and Apremilast (Apr). Materials & methods: Data from an observational study were used to calculate adherence using the Proportion of Days Covered (PDC) method and persistence. Results & conclusion: Treatment adherence was found to be good for all the drugs studied across all years of analysis, while persistence was suboptimal, showing a marked decrease from the third year of study onward. In the treatment of PsO, greater attention needs to be paid to treatment persistence.

Plain language summary

This summary explains that when a patient follows their doctor's medication instructions and continues using the same medication over time to treat a condition like psoriasis, they can expect safer and more effective outcomes. This study examined these aspects to assess how different medications perform over the long term and to explore ways to improve their prescription. The findings highlight that the main issue is not so much in following instructions but in continuing to use the same medication throughout the treatment duration. Raising awareness among healthcare professionals about these issues is crucial to help patients maintain consistent therapy over time and improve their care pathway.

Summary points

• Adherence and persistence are deemed critical for the safety and effectiveness of chronic therapies such as psoriasis. This multicentric study explored adherence, persistence and therapy switching in psoriasis patients over 1 to 5 years of treatment.

• Treatment adherence across all studied drugs and years consistently exceeded 80%, underscoring the safety of these therapies.

• Patients showed treatment persistence up to the second year, which then gradually declined through the fifth year.

• Comparing naive and experienced patients, naive patients consistently demonstrated higher persistence.

• Regarding therapy switching, most patients did not switch to another therapy, indicating a need for further investigation.

• For patients with psoriasis undergoing home treatment with biologic and targeted synthetic disease-modifying antirheumatic drugs, adherence is not a concern.

• Long-term therapies face a persistence issue, highlighting a need for healthcare providers to focus on improving patient care pathways.

• Real-life studies present a valuable opportunity for direct drug comparisons with the same indications, offering insights to optimize psoriasis treatment.

Keywords: :

• biologic and targeted synthetic disease-modifying antirheumatic drugs
• discontinuation
• drug utilization research
• medication adherence
• persistence
• psoriasis
• real-life analysis
• treatment switching

Author contributions

Each authors contributed (a) to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (b) drafting the work or revising it critically for important intellectual content; AND (c) final approval of the version to be published; AND (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

All authors report no conflicts of interest, with the exception of Enrico Pasut, who provided consultancy services for Biogen in 2020. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.