Psoriatic arthritis (PsA) is an inflammatory joint disease that denotes a heterogeneous group of arthritides that may be present with or without obvious psoriatic lesions; therefore, treatment is largely driven by the location and severity of articular and skin involvement. Rheumatologists, who generally manage the disease, commonly divide patients into three segments for the purposes of defining a course of treatment: patients with peripheral arthritis, patients with axial disease, and patients with both peripheral and axial disease. Patients with peripheral disease are generally treated with conventional disease-modifying antirheumatic drugs (DMARDs) first line, after which they may transition to a second conventional DMARD and/or a tumor necrosis factor alpha (TNF-α) inhibitor. NSAIDs are prescribed first line for axial disease, followed by TNF-α inhibitors in the second line of therapy (although payers may require patients fail conventional DMARDs before biologic therapy as in peripheral disease despite the lack of efficacy of conventional DMARDs in treating axial disease). Patients with peripheral and axial manifestations may be treated with NSAIDs and/or conventional DMARDs before anti-TNF-α therapy. Five tumor necrosis factor alpha (TNF-α) inhibitors, including the most recently approved agent in this class—Cimzia (UCB’s certolizumab pegol)—are approved in the United States for PsA, as is the recently approved interleukin (IL)-12/23 inhibitor, Stelara (Janssen’s ustekinumab). Other biological therapies approved to treat rheumatoid arthritis (e.g., Orencia [Bristol-Myers Squibb’s abatacept]) may be prescribed off-label for moderate to severe PsA. Using patient-level claims data, this report tracks the share of disease-modifying PsA drugs through lines of therapy, evaluates treatment flow, and analyzes why certain key therapies are chosen over others.
Questions Answered in This Report:
- Newly diagnosed patients: More than one-half (55.6%) of newly diagnosed PsA patients began treatment with a DMARD within the first year following 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: Two-thirds of drug-treated PsA patients filled a prescription for a TNF-α inhibitor in Q4 2013, a trend that has remained largely unchanged over the past four quarters of analysis. Which specific drugs garner the most patient share for recently treated PsA patients? When do patients progress from one therapy to the next in PsA, and how does this pattern differ among key drugs? Are most recently treated patients for each key brand coming from new (adds/switches) or continuing business?
- Pathways to key therapies: Longitudinal claims data reveal relatively consistent use of TNF-α inhibitors and conventional DMARDs among recently treated patients; despite limited use of non-TNF biologics, patient share analysis reveals increased use of newly approved biologic DMARDs in 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 on PsA?
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 PsA (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 696.0) 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.