Patients with psoriatic arthritis (PsA) who initiated treatment with an interleukin (IL) 12/23 inhibitor or IL-17 inhibitor had a greater comorbidity burden compared with those who initiated treatment with a tumor necrosis factor (TNF) inhibitor; however, treatment persistence was similar between the 2 groups, according to the results of a study published in Journal of Managed Care and Specialty Pharmacy.

The researchers sought to examine the characteristics of patients with PsA and their association with initiation of TNF inhibitors vs IL-12/23 or IL-17 inhibitors. Researchers also aimed to compare treatment persistence among patients who received TNF inhibitors vs IL-12/23 or IL-17 inhibitors as first-line biologic therapy in a real-world setting in the US.

The primary study outcome was treatment persistence, defined as continuous use of the index drug at 1 year, regardless of gaps between refills. The secondary outcome was treatment persistence with high adherence at 1 year (ie, refill gaps at ≤30 days).


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A cohort study was conducted that included claims data from the IBM Market Scan between January 2013 and December 2017. A total of 3180 patients who initiated TNF inhibitors and 214 patients who initiated IL-12/23 or IL-17 inhibitors were included in the study.

Patients who initiated IL-12/23 or IL-17 inhibitors had more comorbidities compared with those who initiated TNF inhibitors (mean combined comorbidity score, 0.9 vs 0.3, respectively).

Treatment persistence was similar among the TNF and IL groups (53.0% vs 53.7%, respectively). Treatment persistence with high adherence was reported in 37.1% of patients who initiated TNF inhibitors compared with 24.8% of those who initiated IL-12/23 or IL-17 inhibitors.

Following adjustment for baseline characteristics, the researchers did not observe any difference at 1 year of treatment persistence between the 2 groups (adjusted odds ratio [aOR] for TNF inhibitors vs IL-12/23 or IL-17 inhibitors, 0.86; 95% CI, 0.63-1.15). Further, the use of TNF inhibitors was associated with greater treatment persistence with high adherence compared with the use of IL-12/23 or IL-17 inhibitors (aOR, 1.61; 95% CI, 1.15-2.26).

Study limitations included potential residual confounding, the inability to address physician and patient preferences, and the small number of patients initiating treatment with ixekizumab.

The researchers concluded, “Our findings provide a new insight into treatment patterns that compares TNF inhibitors vs newer biologic drugs for PsA, IL-12/23 or 17 inhibitors, in a real-world setting.”

Disclosure: Multiple study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Jin Y, Chen SK, Lee H, Landon JE, Merola JF, Kim SC. Patient characteristics associated with use of TNF vs interleukin inhibitors as first-line biologic treatment for psoriatic arthritis. J Manag Care Spec Pharm. 2021;27(8):1106-1117. doi:10.18553/jmcp.2021.27.8.1106