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Objectives: To compare treatment patterns and costs among psoriasis patients with and without metabolic conditions newly initiating a biologic or apremilast., Methods: Adult patients included had ≥1 prescription for secukinumab, adalimumab, ustekinumab, etanercept, or apremilast between 01/01/2015 and 08/31/2018 (date of first prescription was index date) and no index drug use in the 12-months pre-index, and continuous enrollment in the 12-month pre-index and 24-month post-index periods. Patients were divided into mutually exclusive treatment cohorts and stratified by their pre-index metabolic condition status. Treatment patterns (adherence, non-persistence, switching, discontinuation, use of combination therapy, and re-initiation) and healthcare costs were compared., Results: Overall, 7773 patients were included; 47.5-56.7% had a metabolic condition. Except for the apremilast group, patients with metabolic conditions had higher discontinuation (secukinumab: 50.6% vs. 43.7%; adalimumab*: 53.9% vs. 48.7%; ustekinumab*: 41.9% vs. 35.1%; etanercept: 42.8% vs. 41.2%; apremilast: 43.1% vs. 46.1%) and switching (secukinumab: 48.1% vs. 41.2%; adalimumab*: 47.8% vs. 41.9%; ustekinumab*: 34.5% vs. 25.3%; etanercept*: 53.6% vs. 51.5%; apremilast: 45.8% vs. 44.6%) than patients without (* p  < .05). Patients with metabolic conditions incurred significantly higher costs., Conclusion: Many psoriasis patients initiating biologics or apremilast had metabolic conditions. These patients had higher discontinuation and switching, and significantly higher healthcare costs.

Background: There is limited evidence regarding biologics dosing patterns and its costs among psoriasis patients in the United Kingdom (UK). Objective: This retrospective study assessed biologics dose increase beyond labelled dose and associated UK pharmacy costs in moderate to severe psoriasis patients. Methods: Adult psoriasis patients on biologic prescription for ≥12 continuous months between January 2010 and March 2015 with their diagnosis recorded in the UK Hospital Treatment Insights Database within one month of such prescription were included. The proportion of patients receiving ≥30% higher the average daily maintenance dose as per the UK product label, and associated 12-month costs were reported. Results: The study included 362 patients, receiving adalimumab (48%), etanercept (17%), ustekinumab (12%), and infliximab (23%). Beyond labelled dose increase was noted in 14% adalimumab, 20% etanercept, 18% ustekinumab and 28% infliximab patients with an associated mean annual extra cost per patient of £7936, £5912, £2422 and £2275, respectively. Conclusion: Dose increase beyond labelled dose of biologics was commonly observed in moderate to severe psoriasis in the UK and resulted in substantial annual incremental pharmacy costs.

Objective: To compare the cost consequence of biologic drugs for moderate-to-severe psoriasis from the perspective of the Spanish National Health System., Methods: We built a decision tree with a two-year time horizon. Efficacy data for biologics (etanercept, infliximab, adalimumab, ustekinumab and secukinumab) were drawn from published meta-analyses: PASI75 for the induction phase and PASI90 for the rest of follow-up. Patients with PASI < 75 at week 10-16 were switched to another biologic agent. Efficacy at week 24 was considered the highest possible efficacy for each drug and assumed to remain constant throughout the two-year period. Only drug treatment costs were used. The number needed to treat (NNT), annual cost per patient, annual cost per patient with PASI90 (cost per responder) and cost of primary failure (PASI < 75 at first efficacy evaluation) were calculated., Results: Secukinumab monotherapy was associated with the lowest cost per responder, followed by infliximab and ustekinumab. Treatment sequences starting with secukinumab were the most efficient, having the lowest NNT and cost per responder. Although the annual cost per treatment is similar for all drugs, there are huge differences in the cost per responder., Conclusions: Secukinumab as first-line biologic treatment is the most efficient treatment for moderate-to-severe plaque psoriasis in the short-to-medium term.

Background: It is not clear how to best use biologics in the treatment of psoriasis. Our objective was to assess use of a protocol for biological therapies (BT) in psoriasis., Methods: A consensus protocol was established that included the indications for BT and dose optimization. Patient's characteristics, effectiveness, and cost of BT were analyzed before and after the implementation with two cross-sectional studies to assess its impact., Results: About 106 were treated before the protocol and 118 patients were treated after. After implementing the protocol, the dose was reduced in 43.4% of the patients receiving adalimumab, in 37.5% for etanercept, in 28.6% for infliximab, and in 14.7% for ustekinumab. No statistically significant differences were found in PASI score after the implementation of the protocol, except for the percentage of patients that achieved PASI 75 with ustekinumab, which was slightly higher. The global yearly savings achieved with the protocol implementation were 115,969 €., Conclusions: The protocol helped to increase the efficiency of BT, with decreasing doses of BT without affecting treatment effectiveness.

Introduction: The advent of the biological therapies has led health expenditure in dermatology units. This study aims to evaluate, in our regular clinical practice, the patterns of use of etanercept and its influence on efficacy and safety outcomes, as well as the real costs associated with continuous and intermittent treatment regimens., Methods: Observational, retrospective, non-interventionist, and multicenter study to analyze the experience of the treatment with etanercept in the management of moderate-to-severe plaque psoriasis, given according to the daily clinical practice of the Dermatology Departments of the Complejo Hospitalario de Jaén and the Hospital Universitario Virgen del Rocío (Seville)., Results: 83.3% (n = 45) of the 54 patients included in our study received the continuous regimen of Etanercept, whereas 16.7% (n = 9) were given the intermittent regimen. 94.4% (n = 51) of the patients studied began the Etanercept treatment at a dose of 50 mg/week. The mean patient/year cost of the study population is €11 298.80 (95%CI €10 551.40-€12 046.20). Breaking down the first and the second year of treatment by regimen, in the continuous regimen the mean cost would be €12 294.15 and €12 327.05 in the first and the second year, respectively, and €10 302.07 and €4986.51 in the intermittent regimen., Discussion: Etanercept is a biologic that had demonstrated its versatility over the years and permits the individualization of treatment in our patients, thus having a direct impact on drug-related costs. This is well demonstrated in our series, where 94.4% of our patients begin with the dose of 50 mg/d. Our study yields relatively higher figures in patients on continuous therapy, with 77.1% of them maintaining PASI75 at week 24., Conclusions: We present our experience in regular clinical practice with etanercept, showing it to be an effective, safe, and versatile drug that permits patient-tailored treatment, delivering a frankly satisfactory control of our psoriasis patients.