This article is more than 5 years old. Information may no longer be current.

Some patients prescribed biologics also receive topical medications for psoriasis

Megan H. Noe

In patients with psoriasis, the median time between first and last biologic prescriptions was between 3.3 and 7 months with up to 50% of patients not prescribed a second prescription for the medication, according to researchers in Journal of Drugs in Dermatology.

“The median time between first and last prescription in our study is less than what has been reported previously for biologics,” Megan H. Noe, MD, MPH, MSCE, of the department of dermatology at Brigham and Women’s Hospital and Harvard Medical School told Healio Dermatology. “... about half of patients who were receiving prescriptions for the same biologic medication for at least 12 months continued to receive new prescriptions for topical medications, highlighting the complexity of psoriasis treatment, even in the age of targeted biologics.”

The researchers analyzed data from the OptumInSight EHR database to understand prescribing patterns associated with biologic therapies for psoriasis. Patients included were prescribed at least one biologic medication.

Of 37,714 eligible patients with psoriasis who were prescribed at least one biologic medication, 17,888 were women (51.5%) with a mean age of 47.8 years and a median follow-up time in the database of 3.1 years (IQR = 1.5-5.1).

Most patients were white (84.7%) and non-Hispanic (85.7%). One-third of patients (33%) had a history of psoriatic arthritis.

Medical co-morbidities like hyperlipemia, hypertension and obesity were common in the biologics cohort, which corresponds to previous reports, according to researchers.

Adalimumab (Humira, AbbVie) was prescribed most often, in 19,890 patients (43%) followed by 14,108 patients (30.5%) for etanercept (Enbrel, Amgen), 6,561 (14.2%) for ustekinumab (Stelara, Jannen), 2,787 (6.0%) for infliximab (Remicade, Janssen), 2,356 (5.1%) for secukinumab (Cosentyx, Novartis) and 539 (1.2%) for ixekizumab (Taltz, Eli Lilly).

Only one prescription for the biologic was used in 27.7% to 53.1% of patients.

Those prescribed ixekizumab were the least likely to receive a second prescription, according to researchers.

Patients on infliximab had the greatest median time between the first and last prescription (7 months; IQR = 2.9-20.8). In contrast, those on interleukin-17 inhibitors had the shortest median time of 3.3 months for ixekizumab and 3.4 months for secukinumab.

The median time between the first and last prescriptions was 3.3 to 7 months and up to 50% of patients who received a prescriptions for biologic of at least 12 months duration did not receive a second prescription for the same medication.

In a subset of 12,857 patients with biologic medication episodes of at least 12 months duration, researchers identified more than 50% of patients who continued to receive prescriptions for topical therapies, most often topical steroids. These patients had lower rates of medical comorbidities compared with the main study population, with the exception of psoriatic arthritis.

Less than 5% of patients had at least one phototherapy procedure with a median of seven procedures while ongoing biologic therapy.

“Using electronic health records to investigate prescriptions written is a unique way to understand drug utilization that captures more of the treatment selection process, including prescriptions that were written but never filled,” Noe said. – by Abigail Sutton

Disclosure: Noe is supported by a K23-AR073932 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The study was supported by a research grant from Ortho-Dermatologics to the Trustees of the University of Pennsylvania. Please see the full study for all other authors’ relevant financial disclosures.