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Valentina Perrone,1 Serena Losi,2 Silvia Sabatino,2 Maurizio Mezzetti,3 Melania Dovizio,1 Diego Sangiorgi,1 Luca Degli Esposti1 1CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy; 2Eli Lilly Italy S.p.A, Sesto Fiorentino, Italy; 3Eli Lilly Italy S.p.A, Rome, ItalyCorrespondence: Valentina Perrone, CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 544 38393, Fax +39 544 212699, Email valentina.perrone@clicon.itPurpose: An Italian real-world retrospective study was conducted in patients with psoriasis (PSO) to evaluate their characteristics, treatment patterns, and biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) drug utilization.Patients and Methods: The retrospective analysis was carried out on real-world data collected from administrative databases of selected Italian health-departments; the dataset covered approximately 22% of the Italian population. PSO patients (identified by PSO hospitalization, and/or active exemption code and/or a topical anti-psoriatic medication prescription) were included. In prevalent patients identified during 2017– 2018-2019-2020, baseline characteristics and treatment patterns were investigated. Moreover, b/tsDMARD drug utilization (focusing on persistence, monthly dosage, and mean duration between prescriptions) was evaluated in bionaïve patients included during 2015 and 2018.Results: PSO was diagnosed in 241,552 (in 2017), 269,856 (in 2018), 293,905 (in 2019) and 301,639 (in 2020) patients. At the index date, almost 50% of patients had not received systemic medications, and 2% had received biological treatment. Among the b/tsDMARD-treated patients, a decrease in the use of tumour necrosis factor (TNF) inhibitors (60.0– 36.4%, from 2017 to 2020) and an increase in the use of interleukin (IL) inhibitors (36.3– 50.6%, from 2017 to 2020) were observed. In 2018, the persistence rates of TNF inh

Adherence to prescribed medication is important to the management of all diseases, especially those of chronic nature. Drug effectiveness is substantially compromised by therapy nonadherence. We reviewed the available evidences on the impact of patient preferences for therapy on adherence to a prescribed treatment in chronic diseases requiring long-term treatment. A search on PubMed retrieved 699 publications, leading to a selection of 12 publications: 6 on osteoporosis, 2 on moderate-to-severe asthma, 1 on type 1 diabetes, 1 on type 2 diabetes, 1 on kidney transplantation, and 1 on atrial fibrillation. Overall, 8 studies found a positive association between patient preference and adherence to therapy, while the others found no association. In general, overall adherence was considered to be high in the published studies. The reasons for a positive association included reduced dosing frequency, route of administration, lower costs, and favorable safety profile, which is related to the diverse nature of the pathology and its type and duration of treatment. A literature review suggests that achieving good adherence and persistence to therapy requires evaluation of patient preferences. In a period of increasingly limited resources, more effort is warranted to promote better adherence to therapy, especially when patients must self-manage their disease in the long term. Our results further highlight that insufficient attention has been given to the relationship between patient preference and adherence and point out the complex nature of adherence and the need for adequate patient education. More efforts are also needed to better understand the entity of cost savings for payers for specific treatments and the link with patient preference.

Background: Interleukin (IL) inhibitors achieve greater levels of efficacy than older systemic therapies. We calculated the number needed to treat (NNT) of ixekizumab compared with other IL inhibitors approved in Italy for the treatment of moderate-to-severe plaque psoriasis. Methods: The clinical efficacy was evaluated in terms of NNT, based on the results of a recent network meta-analysis (NMA) by the Cochrane Database of Systematic Reviews. The NMA investigated many systemic and biological treatments, but this analysis compared only the efficacy of the following IL inhibitors – brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab – for patients with moderate-to-severe plaque psoriasis. Drugs were compared and ranked according to effectiveness considering the PASI (Psoriasis Area and Severity Index) 90 score. Results: One-hundred and forty trials (51,749 patients) were included in the NMA. Considering the proportion of patients who achieve PASI90, ixekizumab showed the lowest NNT among all comparators (ixekizumab 2.01 [2.46-3.00]; risankizumab 2.05 [2.50-3-05]; guselkumab 2.16 [2.68-3.36]; secukinumab 2.40 [2.90-3.51]; brodalumab 2.61 [3.18-3.88]; ustekinumab 3.44 [4.12-4.95]; tildrakizumab 3.10 [4.15-5.59]. Conclusion: The findings show that ixekizumab is the most effective option (NNT) for the treatment of moderate-to-severe plaque psoriasis.

This analysis was aimed at estimating the cost per responder as measured by number needed to treat of ixekizumab as compared with other biologic drugs approved in Italy for the treatment of moderate-to-severe plaque psoriasis. The clinical efficacy was assessed in terms of number needed to treat, based on a network meta-analysis of published efficacy data as measured by Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) for relevant biologic comparators. The cost was based on the number of administrations dispensed in the first (induction plus maintenance period) and the second (maintenance period only) year of treatment and the ex-factory price net of discounts of each biologic drug. The cost per responder was adopted as a cost-effectiveness indicator. Independent of the Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) used and the year of treatment considered, the cost per number needed to treat for ixekizumab appeared consistently to be the lowest. For example, considering first-year costs and PASI75, the cost per responder for ixekizumab was €16,388, compared to adalimumab (€22,574), etanercept (branded original: €32,420; biosimilar: €21,432), secukinumab (€17,937), and ustekinumab (€20,014). The differences in the cost per responder between ixekizumab and the comparators increased when higher Psoriasis Area and Severity Index response levels were considered. This economic assessment confirmed that ixekizumab is a cost-efficient option from the perspective of the Italian National Health Service for the treatment of moderate-to-severe plaque psoriasis.

Biological disease-modifying antirheumatic drugs are recommended for use particularly in rheumatoid arthritis patients who had an inadequate response to methotrexate but they are costly. In this article, we estimated the number needed to treat and treatment costs associated with the use of baricitinib and adalimumab in moderate to severe rheumatoid arthritis patients who are inadequate responders to methotrexate. We used Efficacy data (American College of Rheumatology indices) from the RA-BEAM trial. For both DMARDs, the number needed to treat was calculated with reference to placebo, using the (American College of Rheumatology indices (ACR20, ACR50, and ACR70 response at 24 weeks)). Direct medical costs (therapy costs of medication) were the only costs considered in the base case analysis. However, administration and monitoring costs were included in the sensitivity analyses. Baricitinib had a lower cost per number needed to treat (ACR20: €10,846.08; ACR50: €12,942.72; and ACR70: €18,506.88) compared to adalimumab (ACR20: €21,124.45; ACR50: €23,945.22; and ACR70: €45,445.77). The most significant cost difference in favor of baricitinib was observed using ACR70 index (−€26,938.89). Sensitivity analysis confirmed these results. This analysis demonstrates that baricitinib represents a more cost-effective option in comparison to adalimumab in the treatment of rheumatoid arthritis patients with an inadequate response to methotrexate in Italy and based on Italian costs.

Walid Fakhouri,1 Pedro Lopez-Romero,2 Silvia Antonelli,3 Serena Losi,4 Veronica Rogai,4 Stefano Buda,5 Diego Sangiorgi,5 Valentina Perrone,5 Luca Degli Esposti5 1Eli Lilly & Company, Erl Wood, UK; 2Eli Lilly & Company, Madrid, Spain; 3Eli Lilly Italy S.p.A., Roma, Italy; 4Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy; 5CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy Objectives: This study aimed to: 1) describe treatment patterns and drug utilization profile (in terms of therapeutic strategy used, switch, persistence and drug consumption variation) among adult patients affected by rheumatoid arthritis (RA), and 2) estimate the health care resource utilization and its associated direct cost for the management of RA patients. Methods: A retrospective cohort analysis, using administrative databases of six Local Health Units in Italy, was performed. All adult patients with a confirmed diagnosis of RA between January 1, 2010 and December 31, 2014 were enrolled. The date of the first RA diagnosis according to the study criteria during the study period represented the index date (ID) for each patient. Patients enrolled were observed from the ID for at least 12 months (follow-up period), and their clinical characteristics were investigated for 12 months prior to the ID.Results: A total of 10,401 patients with a confirmed RA diagnosis were included. Mean age was 63.0 years and 25% were male; 67% of patients were untreated at ID. During the follow-up period, 67.8% of patients treated with biologic agents were persistent with initial therapy, compared to 45.7% for patients on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), while 11% of patients treated with biologic agents switched during the follow-up period, compared to 17.6% of csDMARDs-treated ones. At the end of the follow-up period, 14.7% of all patients in the analysis had an increase and 12.6% of them had a decreas

The reaction between [Mo(3-C3H5)(CO)2(NCMe)2Br] (1) and the ferrocenylamidobenzimidazole ligands FcCO(NH2benzim) (L1) and (FcCO)2(NHbenzim) (L2) led to a binuclear (2) and a trinuclear (3) Mo-Fe complex, respectively. The single-crystal X-ray structure of [Mo(3-C3H5)(CO)2(L2)Br] [L2 = {[(5-C5H5)Fe(5-C5H4CO)]2(2-NH-benzimidazolyl)}] shows that L2 is coordinated to the endo Mo(3-C3H5)(CO)2 group in a 2-N,O-bidentate chelating fashion whereas the MoII centre displays a pseudooctahedral environment with Br occupying an equatorial position. Complex 2 was formulated as [Mo(3-C3H5)(CO)2(L1)Br] on the basis of a combination of spectroscopic data, elemental analysis, conductivity and DFT calculations. L1 acts as a 2-N,N-bidentate ligand. In both L1 and L2, the HOMOs are mainly localised on iron while the C=O bond(s) contribute to the LUMO(s) and the next highest energy orbitals are Fe-allyl antibonding orbitals. When the ligands bind to Mo(3-C3H5)(CO)2Br, the greatest difference is that Mo becomes the strongest contributor to the HOMO. Electrochemical studies show that, in complex 2, no electronic interaction exists between the two ferrocenyl ligands and that the first electron has been removed from the MoII-centred HOMO.