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Background: Real-world data on long-term treatment patterns associated with interleukin-17A inhibitors in plaque psoriasis are lacking.Objective: To compare ixekizumab or secukinumab treatment patterns over a 24-month period among plaque psoriasis patients.Methods: Adult patients with psoriasis who had 1 or more claims for ixekizumab or secukinumab between March 1, 2016, and October 31, 2019, and with 24 months of follow-up after starting treatment were identified from IBM MarketScan claims databases. Inverse probability of treatment weighting and multivariable models were employed to balance cohorts and estimate the risks of nonpersistence, discontinuation, and switching and odds of highly adherent treatment (proportion of days covered ≥ 80%).Results: A total of 471 ixekizumab and 990 secukinumab users were included. Compared to secukinumab, ixekizumab use was associated with a 20% lower risk of nonpersistence (hazard ratio, 0.80; 95% CI, 0.70-0.92), a 17% lower risk of discontinuation (hazard ratio, 0.83; 95% CI, 0.72-0.96), and a 42% higher odds of being highly adherent to treatment (odds ratio, 1.42; 95% CI, 1.12-1.80). No difference in risk of switching was observed (hazard ratio, 0.83; 95% CI, 0.68-1.01).Limitations: Disease severity and clinical outcomes were unavailable.Conclusion: Over 24 months, ixekizumab users exhibited better persistence and adherence, and a lower risk of discontinuation than secukinumab users in real-world settings. [ABSTRACT FROM AUTHOR]

Psoriasis (PsO) is a chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations. The disease is also associated with lower quality of life, lower work productivity, and higher healthcare costs. The objective of this study was to conduct a systematic literature review of the disease burden for PsO in Argentina, Brazil, Colombia, and Mexico. PubMed/MEDLINE, Web of Science, SciELO, and LILACS were searched for publications in English, Spanish, or Portuguese from 2003 to July 2018. A total of 680 records were retrieved and 13 articles were included. In Latin America, PsO has a negative impact on the physical and mental well-being as shown by substantially lower scores on measures of quality of life (eg, 12-item Short-Form Health Survey) for patients than the general population. Patients with PsO reported higher levels of presenteeism, activity impairment, and work productivity loss. The estimated annual costs per patient with PsO in Colombia were $3497.58 and $2160.92 for the private sector and public scenario, respectively. Although evidence on the full cost and impact of PsO in Latin America is scarce and further research is needed, the burden in these regions is significant and comparable with that in other parts of the world. • Psoriasis (PsO) is a disease that has an impact on the physical and quality-of-life domains of a patient and is a burden to the healthcare system. • Limited research has been conducted to quantify the burden of disease of PsO in Latin America. Our research provides an update on this knowledge. • The burden of disease of PsO in Latin America is significant and comparable with that in other parts of the world. [ABSTRACT FROM AUTHOR]

The marginal practice cost of physician services is estimated with the use of a multiproduct, quadratic cost function. Of specific concern are the five physician outputs of office visits, 'other visits,' operations/assists, laboratory tests and relative value unit-weighted diagnostic tests. Marginal practice costs are a significant factor in the proposals to reform the method in which Medicare pays physicians for practice expense.

Background: Cumulative clinical improvement and speed of improvement are important to psoriasis patients.Objective: Compare cumulative benefits of biologics over 12 to 16 weeks in the treatment of moderate to severe psoriasis.Methods: A systematic literature review identified phase III trial data on Psoriasis Area and Severity Index (PASI) responses for biologics during 12 and 16 weeks of treatment. Cumulative clinical benefit, measured by the area under the curve for PASI ≥75% improvement (PASI 75), ≥90% improvement (PASI 90), and 100% improvement (PASI 100), was compared using the network meta-analysis and Bayesian methodology on the relative probability of achieving percentage of maximum area under the curve.Results: Among biologics approved for psoriasis treatment, anti-interleukin-17 biologics demonstrated consistently greater cumulative clinical benefits on PASI 75, PASI 90, and PASI 100 over the 12- or 16-week period than anti-interleukin-23 and other biologics. For biologics with 12-week data, ixekizumab and brodalumab showed greater cumulative benefits for PASI 75, PASI 90, and PASI 100 than secukinumab, followed by guselkumab, infliximab, adalimumab, ustekinumab, and etanercept. Ixekizumab showed greater cumulative benefits than all other biologics reporting 16-week data.Limitations: Recently approved biologics were not included.Conclusion: Ixekizumab (at 12 weeks and 16 weeks) and brodalumab (at 12 weeks) had greater cumulative clinical benefit than all of other biologics studied. [ABSTRACT FROM AUTHOR]

Background: Real-world data on treatment patterns associated with use of interleukin-17A inhibitors in psoriasis are lacking.Objective: To compare treatment patterns between ixekizumab or secukinumab users in clinical practice.Methods: A retrospective cohort study included patients with psoriasis aged ≥18 years treated with ixekizumab or secukinumab between March 1, 2016, and May 31, 2018 in IBM MarketScan (IBM Corp, Armonk, NY) databases. Inverse probability of treatment weighting and multivariable models were used to address cohort imbalances and estimate the risks of nonpersistence (60-day gap), discontinuation (≥90-day gap), switching, and the odds of adherence.Results: The study monitored 645 ixekizumab users for 13.7 months and 1152 secukinumab users for 16.3 months. Ixekizumab users showed higher persistence rate (54.8% vs 45.1%, P < .001) and lower discontinuation rate (37.8% vs 47.5%, P < .001) than secukinumab. After multivariable adjustment, ixekizumab users had lower risks of nonpersistence (hazard ratio, 0.82; 95% confidence interval, 0.71-0.95) and discontinuation (hazard ratio, 0.82; 95% confidence interval, 0.70-0.96), and higher odds of high adherence to treatment measured by a medication possession ratio ≥80% (hazard ratio, 1.31; 95% confidence interval, 1.07-1.60). The risk of switching was similar between cohorts.Limitations: Disease severity and clinical outcomes were unavailable.Conclusion: Ixekizumab users demonstrated longer drug persistence, lower discontinuation rate and risk of discontinuation, higher likelihood of adherence, and similar risk of switching compared with secukinumab users in clinical practices. [ABSTRACT FROM AUTHOR]

Background The prevalence of both lifestyle-related metabolic disorders and osteoporosis is increasing in Asia. Objectives To conduct a systematic review of the published literature to identify studies examining disorders of glucose and lipid metabolism (type 2 diabetes, hyperglycemia, hypercholesterolemia, hyperlipidemia, dyslipidemia, metabolic syndrome [MetS], and atherosclerosis) as risk factors for osteoporosis and fracture in Asian populations. Studies examining the relationship between metabolic disorders and bone mineral density (BMD) were also included. Methods EMBASE (including MEDLINE) and the Cochrane Library were searched. Studies conducted only within Asia, which reported multivariate analysis with a sample size of 200 or more subjects, were included. Results A total of 32 studies were included. All six studies examining diabetes and fracture found that subjects with diabetes had a significantly higher risk of fracture than did subjects without diabetes (risk estimate range 1.26–4.73). Two studies found that subjects with atherosclerosis had a significantly higher risk of fracture (risk estimate range 1.10–2.52). Studies consistently reported that MetS is likely associated with osteoporosis or decreased BMD in men but not women. No consistent association was found for diabetes and BMD, with studies reporting contrasting results. There was limited evidence investigating lipid metabolism and hyperglycemia and risk of fracture or bone loss in Asian populations. Conclusions These findings suggest that diabetes is a risk factor for fracture in Asian populations. MetS may be associated with bone loss in Asian men and atherosclerosis associated with increased fractures; however, caution is needed interpreting these findings given limitations in study design. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: The aging population is expected to increase the burden of osteoporosis on the US health-care system. We developed a methodology for estimating current and future costs of osteoporosis in state populations and applied it to Florida. Methods: We used Florida hospital, population and mortality data, along with national data on outpatient and long-term care, to estimate the cost of osteoporotic fractures in the year 2000. For men and for “other” fractures in women, costs were based on the incidence of hospital admissions for fractures. For hip, spine, and wrist fractures in women, we integrated hospital and nonhospital fracture incidence in a Markov model of osteoporosis. Consecutive cohorts were run by race for each age, 50 to 99 years, to estimate the number and cost of incident fractures. Ongoing costs of prevalent fractures in women were estimated using postfracture health states for each individual age cohort. Total costs and fractures for the years 2001 through 2025 were projected by multiplying the base-year cost and fracture distribution by age-, sex-, and race-specific population growth rates. Results: In Florida, 86,428 osteoporotic fractures were estimated to occur in the year 2000 at a cost of $1,238,445,114. By 2025, the estimated number of incident fractures would increase to 151,622, at a cost of $2,135,130,564. Conclusions: This disease-modeling approach generates detailed information on the current and future cost burden of osteoporosis for an individual state popula-tion. Predictions based on this methodology may enable health-policy decisions that are tailored to local needs. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Approximately 700,000 vertebral fractures occur annually in the United States. Available estimates on hospital costs and length of stay for vertebral fractures do not reflect current practice patterns, nor has post-acute care utilization been reported in sufficient detail. This paper provides new estimates on acute care charges, length-of-stay (LOS), and distribution patterns of post-acute care for osteoporotic vertebral fractures in women aged 50 years and older in the United States. Methods: The Nationwide Inpatient Sample (NIS) database (1997) was used to identify admissions with a primary diagnosis of vertebral fracture. Decision rules based on clinical criteria were developed to identify vertebral fracture cases considered to be osteoporosis-related. Charges, LOS and discharge disposition were analyzed according to patient demographics and hospital characteristics. Results: In 1997, there were 53,066 hospital admissions for osteoporotic vertebral fractures in women. Mean charges and LOS were $9,532 and 6.2 days, respectively, while US totals were $506 million and 329,000 days. More than 40% were discharged to long-term care (LTC); another 24.3% required other follow-up care. Charges and LOS were inversely related to age. Female patients aged 75 or more were more than five times as likely to be discharged to LTC compared to women between the ages of 50 and 64. Charges and LOS were in general, significantly higher for patients in the Northeast, urban areas, teaching hospitals and in larger hospitals, and for patients transferred from other acute care hospitals. Conclusions: Vertebral fractures are more expensive and resource-intensive than previously reported. Furthermore, total costs may be much greater when the components of post-acute care are fully captured. [ABSTRACT FROM AUTHOR]

Background: Ixekizumab has demonstrated improvement in patients with moderate-to-severe psoriasis by selectively targeting interleukin-17A, which is a proinflammatory cytokine that is important in the pathogenesis of psoriasis.Objective: To report 4-year efficacy and safety results from the open-label extension (OLE) of this phase 2 trial.Methods: Analysis was by last observation carried forward. Patients received ixekizumab, 120 mg, and then 80 mg subcutaneously once every 4 weeks.Results: Of the patients who completed the randomized placebo-controlled trial, 93% entered the OLE. A 75% reduction in the Psoriasis Area Severity Index score was reported in 82% of patients at week 208 of the OLE. A static Physician's Global Assessment score of 0 or 1 was reported in 64% of patients, and a score of 0 was reported in 45% at week 208. Patients' Dermatology Life Quality Index and Itch Visual Analog Scale scores decreased when compared with baseline. Improvements were observed in other efficacy and health outcome measures. Serious adverse events were observed in 16.7% of patients, and 87% had 1 or more treatment-emergent adverse events. Three patients had serious infections. One patient reported 2 major cardiovascular events.Limitations: The study was unblinded and lacked a placebo or active comparator.Conclusions: Efficacy was shown to be maintained for up to 4 years of ixekizumab treatment. [ABSTRACT FROM AUTHOR]

Abstract: Background: The National Cholesterol Education Program Adult Treatment Panel III guidelines recommend maintaining lipid levels within particular targets to reduce the risk of coronary heart disease (CHD) events. Objective: The objective of this simulation study was to evaluate the cost-effectiveness of following guideline-recommended care compared with current practice or usual care for patients with diabetes mellitus (DM) and mixed dyslipidemia (ie, high low-density lipoprotein cholesterol [LDL-C] and triglyceride [TG] levels). Methods: A simulation model using a US health care payer perspective was designed to predict changes in lipid levels (LDL-C, TG, high-density lipoprotein cholesterol, and total cholesterol) and long-term CHD risk. Data about patients with DM and uncontrolled TG and/or LDL-C were taken from an electronic medical records database to develop the description of current care (eg, statin, fibrate, or no medication) and cholesterol levels. Patients with uncontrolled lipid levels who were not following guideline recommendations were assumed to be receiving combination treatment (ie, coadministration of statin and fibrate) or monotherapy for the uncontrolled lipids under guideline care. Results from a previous study were used to project incremental benefits of combination treatment compared with monotherapy. CHD events were predicted based on risk equations. A 20-year model of direct costs and quality-adjusted life-years (QALYs) was created. Results: Among patients switched to guideline therapy, the model predicted 72% achieved 2 lipid targets and 44% achieved 3 lipid targets in 1 year. Over 20 years, in a modeled sample of 1000 patients, 176 myocardial infarction and angina events would be avoided by following guideline care. Total present value of costs for drug treatment and medical care for CHD events would be $33,626 per patient for guideline treatment versus $25,264 per patient for current care. The discounted QALY gain would be 0.18 per patient for an incremental cost per QALY of $50,315. Conclusions: The results of this model simulation suggest that for patients with DM and mixed dyslipi-demia, following treatment guidelines rather than current practice (including combination therapy rather than monotherapy) would result in more patients achieving lipid targets, fewer CHD events, and more QALYs gained at a reasonable cost (less than $109,000) per QALY. [Copyright &y& Elsevier]