Psoriasis is a chronic inflammatory skin disorder that, although non-life-threatening, can have a major impact on patients’ quality of life depending on its severity and location on the body. The disease is generally characterized as mild or moderate to severe. Although many patients, particularly those with mild disease, either forgo treatment or are treated solely with a topical therapy, those with moderate to severe disease generally require systemic therapies, which include phototherapy and conventional and biological therapies, to control their disease. Topical therapies remain the mainstay of psoriasis treatment; however, heightened awareness of psoriasis as a systemic disorder has led to greater use of both conventional and biological systemic agents. In the moderate to severe psoriasis segment, the suboptimal side-effect profiles of the commonly used conventional systemics (i.e., methotrexate and cyclosporine) have opened the playing field to biologics. Four biologics are approved for psoriasis: the tumor necrosis factor-alpha (TNF-α) inhibitors Enbrel (Amgen/Stiefel/Pfizer’s etanercept), Humira (AbbVie’s adalimumab), and Remicade (Janssen’s infliximab) and the interleukin-12/23 inhibitor Stelara (Janssen’s ustekinumab). When choosing among these drugs, dermatologists increasingly prescribe Humira rather than Enbrel as a first-line TNF-α inhibitor and reserve Remicade for the most severe psoriasis. As the most recently approved biologic, Stelara, with its novel mechanism of action, is typically reserved for psoriasis patients whose disease is refractory to TNF-α inhibitors; however, owing to its favorable clinical profile and superior convenience, it has experienced strong uptake in psoriasis since its launch. Using patient-level claims data, this report tracks the share of currently marketed psoriasis drugs by line of therapy, evaluates therapy flow, and analyzes why key therapies are chosen over others.
Questions Answered in This Report:
- Newly diagnosed patients: Approximately two-thirds of psoriasis patients begin treatment with a key therapy within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?
- Recently treated patients: Consistent with historical treatment patterns, the topical corticosteroid class continues to capture the majority of recently treated patient prescriptions. Which specific drugs garner the most patient share among recently treated psoriasis patients? When do patients progress from one therapy to the next in psoriasis, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?
- Pathways to key therapies: Longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients; use of TNF-α inhibitors and immunosuppressants for psoriasis increases in the later lines of therapy. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for psoriasis?
Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet and presents claims that are less than six months old at the time of publication.
Patient Sample: Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for psoriasis (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 696.1) during the study period..
Quantified lines of therapy analyses show exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.
Newly Diagnosed Patients:
- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.
- Patient flowcharts through one year of treatment for all first-line products, including progression rates and add/switch behavior.
- Polypharmacy and key concomitant therapies by line of therapy.
- Quarterly trending of patient share by line of therapy.
Recently Treated Patients:
- Quarterly snapshot of patient share by drug class and key products.
- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.
- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.
- Polypharmacy and key concomitant therapies.
- Drug persistence and compliance.
- Quarterly trends in patient share for all key therapies.