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Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Treatment patterns and costs for anti-TNFα biologic therapy in patients with psoriatic arthritis

Authors: Jacqueline B. Palmer, Yunfeng Li, Vivian Herrera, Minlei Liao, Melody Tran, Zafer E. Ozturk

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

Real-world data regarding anti-tumor necrosis factor alpha (anti-TNFα) biologic therapy use in psoriatic arthritis (PsA) are limited; therefore, we described treatment patterns and costs of anti-TNFα therapy in PsA patients in the United States.

Methods

PsA patients (N = 990) aged ≥18 years who initiated anti-TNFα therapy were selected from MarketScan claims databases (10/1/2009 to 9/30/2010). Number of patients on first- (n = 881), second- (n = 72), or third- or greater (n = 37) line of anti-TNFα therapy, persistence, time-to-switch or modification, pharmacy and medical costs (measured per patient per month [PPPM]) for each line of therapy were observed during the 3-year follow-up.

Results

PsA patients receiving only one line of anti-TNFα therapy remained on first-line for ~17 months while those who switched to second- or third- or greater persisted on first-line for ~11 to 12 months, respectively. Time to first-line modification was longer for patients who switched to third- or greater line therapy (7 months) than those who did not switch or switched to second-line (range, ~2 to 4 months). Time-to-switch and time to first-line modification was progressively shorter with each line of therapy for patients who received third- or greater line. PPPM medical costs were higher for patients who did not switch ($322) than those who switched to second- ($167) or third- or greater ($217) line. PPPM pharmacy costs were greater for patients with third- or greater line therapy ($2539) than those who did not switch ($1985) or switched to second-line ($2045).

Conclusion

While the majority of patients received only one line of anti-TNFα therapy, a subset of patients switched to multiple lines of therapy during the 3-year follow-up period. Persistence and therapy modifications differed between these patients and those receiving only one line. Overall medical costs were highest for patients who did not switch, and pharmacy costs increased as patients switched to each new line of therapy.
Literature
2.
go back to reference Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, Dougados M, Hermann KG, Landewe R, Maksymowych W et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1–44.CrossRefPubMed Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, Dougados M, Hermann KG, Landewe R, Maksymowych W et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1–44.CrossRefPubMed
3.
go back to reference Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, Burgos-Vargas R, Collantes-Estevez E, Davis J, Dijkmans B et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770–6.CrossRefPubMed Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, Burgos-Vargas R, Collantes-Estevez E, Davis J, Dijkmans B et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770–6.CrossRefPubMed
4.
go back to reference Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25–31.CrossRefPubMed Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25–31.CrossRefPubMed
5.
go back to reference Cantini F, Niccoli L, Nannini C, Kaloudi O, Bertoni M, Cassara E. Psoriatic arthritis: a systematic review. Int J Rheum Dis. 2010;13(4):300–17.CrossRefPubMed Cantini F, Niccoli L, Nannini C, Kaloudi O, Bertoni M, Cassara E. Psoriatic arthritis: a systematic review. Int J Rheum Dis. 2010;13(4):300–17.CrossRefPubMed
6.
go back to reference Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. P & T. 2010;35(12):680–9. Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. P & T. 2010;35(12):680–9.
7.
go back to reference Krueger GG. Clinical features of psoriatic arthritis. Am J Manag Care. 2002;8(6 Suppl):S160–170.PubMed Krueger GG. Clinical features of psoriatic arthritis. Am J Manag Care. 2002;8(6 Suppl):S160–170.PubMed
9.
go back to reference Naldi L, Mercuri SR. Epidemiology of comorbidities in psoriasis. Dermatol Ther. 2010;23(2):114–8.CrossRefPubMed Naldi L, Mercuri SR. Epidemiology of comorbidities in psoriasis. Dermatol Ther. 2010;23(2):114–8.CrossRefPubMed
10.
go back to reference Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, Gladman DD. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res. 2011;63(12):1729–35.CrossRef Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, Gladman DD. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res. 2011;63(12):1729–35.CrossRef
11.
go back to reference Rosen CF, Mussani F, Chandran V, Eder L, Thavaneswaran A, Gladman DD. Patients with psoriatic arthritis have worse quality of life than those with psoriasis alone. Rheumatology. 2012;51(3):571–6.CrossRefPubMed Rosen CF, Mussani F, Chandran V, Eder L, Thavaneswaran A, Gladman DD. Patients with psoriatic arthritis have worse quality of life than those with psoriasis alone. Rheumatology. 2012;51(3):571–6.CrossRefPubMed
12.
go back to reference Ackermann C, Kavanaugh A. Economic burden of psoriatic arthritis. Pharmacoeconomics. 2008;26(2):121–9.CrossRefPubMed Ackermann C, Kavanaugh A. Economic burden of psoriatic arthritis. Pharmacoeconomics. 2008;26(2):121–9.CrossRefPubMed
13.
go back to reference American Academy of Dermatology Work G, Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.CrossRef American Academy of Dermatology Work G, Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.CrossRef
14.
go back to reference Gossec L, Smolen JS, Gaujoux-Viala C, Ash Z, Marzo-Ortega H, van der Heijde D, FitzGerald O, Aletaha D, Balint P, Boumpas D et al. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis. 2012;71(1):4–12.CrossRefPubMed Gossec L, Smolen JS, Gaujoux-Viala C, Ash Z, Marzo-Ortega H, van der Heijde D, FitzGerald O, Aletaha D, Balint P, Boumpas D et al. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis. 2012;71(1):4–12.CrossRefPubMed
15.
go back to reference Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, Kavanaugh A, Kvien TK, Landewe R, Luger T et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis. 2014;73(1):6–16.CrossRefPubMed Smolen JS, Braun J, Dougados M, Emery P, Fitzgerald O, Helliwell P, Kavanaugh A, Kvien TK, Landewe R, Luger T et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis. 2014;73(1):6–16.CrossRefPubMed
16.
17.
go back to reference Day MS, Nam D, Goodman S, Su EP, Figgie M. Psoriatic arthritis. J Am Acad Orthop Surg. 2012;20(1):28–37.PubMed Day MS, Nam D, Goodman S, Su EP, Figgie M. Psoriatic arthritis. J Am Acad Orthop Surg. 2012;20(1):28–37.PubMed
24.
go back to reference Mease P. Psoriatic arthritis and spondyloarthritis assessment and management update. Curr Opin Rheumatol. 2013;25(3):287–96.CrossRefPubMed Mease P. Psoriatic arthritis and spondyloarthritis assessment and management update. Curr Opin Rheumatol. 2013;25(3):287–96.CrossRefPubMed
26.
go back to reference Nash P, Lubrano E, Cauli A, Taylor WJ, Olivieri I, Gladman DD. Updated guidelines for the management of axial disease in psoriatic arthritis. J Rheumatol. 2014;41(11):2286–9.CrossRefPubMed Nash P, Lubrano E, Cauli A, Taylor WJ, Olivieri I, Gladman DD. Updated guidelines for the management of axial disease in psoriatic arthritis. J Rheumatol. 2014;41(11):2286–9.CrossRefPubMed
27.
go back to reference Felquer ML, Soriano ER. New treatment paradigms in psoriatic arthritis: an update on new therapeutics approved by the U.S. Food and Drug Administration. Curr Opin Rheumatol. 2015;27(2):99–106.CrossRefPubMed Felquer ML, Soriano ER. New treatment paradigms in psoriatic arthritis: an update on new therapeutics approved by the U.S. Food and Drug Administration. Curr Opin Rheumatol. 2015;27(2):99–106.CrossRefPubMed
28.
go back to reference Fagerli KM, Lie E, van der Heijde D, Heiberg MS, Lexberg AS, Rodevand E, et al. The role of methotrexate co-medication in TNF-inhibitor treatment in patients with psoriatic arthritis: results from 440 patients included in the NOR-DMARD study. Ann Rheum Dis. 2014;73(1):132–7.CrossRefPubMed Fagerli KM, Lie E, van der Heijde D, Heiberg MS, Lexberg AS, Rodevand E, et al. The role of methotrexate co-medication in TNF-inhibitor treatment in patients with psoriatic arthritis: results from 440 patients included in the NOR-DMARD study. Ann Rheum Dis. 2014;73(1):132–7.CrossRefPubMed
29.
go back to reference Coates LC, Kavanaugh AF, Mease PJ, Ritchlin CT. GRAPPA Treatment Recommendations: An Update from the GRAPPA 2014 Annual Meeting and GRAPPA Meeting Adjacent to the 2014 ACR Meeting. J Rheumatol. 2015;42:1052–5.CrossRef Coates LC, Kavanaugh AF, Mease PJ, Ritchlin CT. GRAPPA Treatment Recommendations: An Update from the GRAPPA 2014 Annual Meeting and GRAPPA Meeting Adjacent to the 2014 ACR Meeting. J Rheumatol. 2015;42:1052–5.CrossRef
30.
go back to reference Coates LC, Ritchlin CT, Kavanaugh AF. GRAPPA treatment recommendations: an update from the GRAPPA 2013 Annual Meeting. J Rheumatol. 2014;41(6):1237–9.CrossRefPubMed Coates LC, Ritchlin CT, Kavanaugh AF. GRAPPA treatment recommendations: an update from the GRAPPA 2013 Annual Meeting. J Rheumatol. 2014;41(6):1237–9.CrossRefPubMed
31.
go back to reference Zhang HF, Gauthier G, Hiscock R, Curtis JR. Treatment patterns in psoriatic arthritis patients newly initiated on oral nonbiologic or biologic disease-modifying antirheumatic drugs. Arthritis Res Ther. 2014;16(4):420.CrossRefPubMedPubMedCentral Zhang HF, Gauthier G, Hiscock R, Curtis JR. Treatment patterns in psoriatic arthritis patients newly initiated on oral nonbiologic or biologic disease-modifying antirheumatic drugs. Arthritis Res Ther. 2014;16(4):420.CrossRefPubMedPubMedCentral
32.
go back to reference Zhu B, Edson-Heredia E, Gatz JL, Guo J, Shuler CL. Treatment patterns and health care costs for patients with psoriatic arthritis on biologic therapy: a retrospective cohort study. Clin Ther. 2013;35(9):1376–85.CrossRefPubMed Zhu B, Edson-Heredia E, Gatz JL, Guo J, Shuler CL. Treatment patterns and health care costs for patients with psoriatic arthritis on biologic therapy: a retrospective cohort study. Clin Ther. 2013;35(9):1376–85.CrossRefPubMed
33.
go back to reference Yeaw J, Watson C, Fox KM, Schabert VF, Goodman S, Gandra SR. Treatment patterns following discontinuation of adalimumab, etanercept, and infliximab in a US managed care sample. Adv Ther. 2014;31(4):410–25.CrossRefPubMed Yeaw J, Watson C, Fox KM, Schabert VF, Goodman S, Gandra SR. Treatment patterns following discontinuation of adalimumab, etanercept, and infliximab in a US managed care sample. Adv Ther. 2014;31(4):410–25.CrossRefPubMed
34.
go back to reference Bonafede M, Fox KM, Watson C, Princic N, Gandra SR. Treatment patterns in the first year after initiating tumor necrosis factor blockers in real-world settings. Adv Ther. 2012;29(8):664–74.CrossRefPubMed Bonafede M, Fox KM, Watson C, Princic N, Gandra SR. Treatment patterns in the first year after initiating tumor necrosis factor blockers in real-world settings. Adv Ther. 2012;29(8):664–74.CrossRefPubMed
35.
go back to reference Howe A, Eyck LT, Dufour R, Shah N, Harrison DJ. Treatment patterns and annual drug costs of biologic therapies across indications from the Humana commercial database. J Manag Care Spec Pharm. 2014;20(12):1236–44.PubMed Howe A, Eyck LT, Dufour R, Shah N, Harrison DJ. Treatment patterns and annual drug costs of biologic therapies across indications from the Humana commercial database. J Manag Care Spec Pharm. 2014;20(12):1236–44.PubMed
36.
go back to reference Ogdie A, Schwartzman S, Husni ME. Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol. 2015;27(2):118–26.CrossRefPubMed Ogdie A, Schwartzman S, Husni ME. Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol. 2015;27(2):118–26.CrossRefPubMed
37.
go back to reference Helliwell PS, FitzGerald O, Fransen J, Gladman DD, Kreuger GG, Callis-Duffin K, et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann Rheum Dis. 2013;72(6):986–91.CrossRefPubMed Helliwell PS, FitzGerald O, Fransen J, Gladman DD, Kreuger GG, Callis-Duffin K, et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann Rheum Dis. 2013;72(6):986–91.CrossRefPubMed
38.
go back to reference Schabert VF, Watson C, Joseph GJ, Iversen P, Burudpakdee C, Harrison DJ. Costs of tumor necrosis factor blockers per treated patient using real-world drug data in a managed care population. J Manag Care Pharm. 2013;19(8):621–30.PubMed Schabert VF, Watson C, Joseph GJ, Iversen P, Burudpakdee C, Harrison DJ. Costs of tumor necrosis factor blockers per treated patient using real-world drug data in a managed care population. J Manag Care Pharm. 2013;19(8):621–30.PubMed
39.
go back to reference Wu N, Lee YC, Shah N, Harrison DJ. Cost of biologics per treated patient across immune-mediated inflammatory disease indications in a pharmacy benefit management setting: a retrospective cohort study. Clin Ther. 2014;36(8):1231–41. 1241 e1231-1233.CrossRefPubMed Wu N, Lee YC, Shah N, Harrison DJ. Cost of biologics per treated patient across immune-mediated inflammatory disease indications in a pharmacy benefit management setting: a retrospective cohort study. Clin Ther. 2014;36(8):1231–41. 1241 e1231-1233.CrossRefPubMed
40.
go back to reference Bonafede M, Joseph GJ, Princic N, Harrison DJ. Annual acquisition and administration cost of biologic response modifiers per patient with rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis. J Med Econ. 2013;16(9):1120–8.CrossRefPubMed Bonafede M, Joseph GJ, Princic N, Harrison DJ. Annual acquisition and administration cost of biologic response modifiers per patient with rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis. J Med Econ. 2013;16(9):1120–8.CrossRefPubMed
41.
go back to reference Danielson E: Health Research Data for the Real World: The MarketScan® Databases (White Paper). 2014. Danielson E: Health Research Data for the Real World: The MarketScan® Databases (White Paper). 2014.
44.
go back to reference Palmer JB, LI Y, Tsang Y, Liao M, Ozturk Z: Treatment patterns and costs for anti-TNFα therapy in patients with ankylosing spondylitis. Rheumatology (Sunnyvale) 2015, (in press). Palmer JB, LI Y, Tsang Y, Liao M, Ozturk Z: Treatment patterns and costs for anti-TNFα therapy in patients with ankylosing spondylitis. Rheumatology (Sunnyvale) 2015, (in press).
52.
go back to reference Glintborg B, Ostergaard M, Krogh NS, Andersen MD, Tarp U, Loft AG, Lindegaard HM, Holland-Fischer M, Nordin H, Jensen DV et al. Clinical response, drug survival, and predictors thereof among 548 patients with psoriatic arthritis who switched tumor necrosis factor alpha inhibitor therapy: results from the Danish Nationwide DANBIO Registry. Arthritis Rheum. 2013;65(5):1213–23.CrossRefPubMed Glintborg B, Ostergaard M, Krogh NS, Andersen MD, Tarp U, Loft AG, Lindegaard HM, Holland-Fischer M, Nordin H, Jensen DV et al. Clinical response, drug survival, and predictors thereof among 548 patients with psoriatic arthritis who switched tumor necrosis factor alpha inhibitor therapy: results from the Danish Nationwide DANBIO Registry. Arthritis Rheum. 2013;65(5):1213–23.CrossRefPubMed
53.
go back to reference Glintborg B, Ostergaard M, Dreyer L, Krogh NS, Tarp U, Hansen MS, Rifbjerg-Madsen S, Lorenzen T, Hetland ML. Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor alpha therapy: results from the nationwide Danish DANBIO registry. Arthritis Rheum. 2011;63(2):382–90.CrossRefPubMed Glintborg B, Ostergaard M, Dreyer L, Krogh NS, Tarp U, Hansen MS, Rifbjerg-Madsen S, Lorenzen T, Hetland ML. Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor alpha therapy: results from the nationwide Danish DANBIO registry. Arthritis Rheum. 2011;63(2):382–90.CrossRefPubMed
54.
go back to reference Heiberg MS, Koldingsnes W, Mikkelsen K, Rodevand E, Kaufmann C, Mowinckel P, Kvien TK. The comparative one-year performance of anti-tumor necrosis factor alpha drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Rheum. 2008;59(2):234–40.CrossRefPubMed Heiberg MS, Koldingsnes W, Mikkelsen K, Rodevand E, Kaufmann C, Mowinckel P, Kvien TK. The comparative one-year performance of anti-tumor necrosis factor alpha drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Rheum. 2008;59(2):234–40.CrossRefPubMed
55.
go back to reference Glintborg B, Ostergaard M, Krogh NS, Tarp U, Manilo N, Loft AG, Hansen A, Schlemmer A, Fana V, Lindegaard HM et al. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor alpha inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013;72(7):1149–55.CrossRefPubMed Glintborg B, Ostergaard M, Krogh NS, Tarp U, Manilo N, Loft AG, Hansen A, Schlemmer A, Fana V, Lindegaard HM et al. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor alpha inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013;72(7):1149–55.CrossRefPubMed
56.
go back to reference Fabbroni M, Cantarini L, Caso F, Costa L, Pagano VA, Frediani B, Manganelli S, Galeazzi M. Drug retention rates and treatment discontinuation among anti-TNF-alpha agents in psoriatic arthritis and ankylosing spondylitis in clinical practice. Mediators Inflamm. 2014;2014:862969.CrossRefPubMedPubMedCentral Fabbroni M, Cantarini L, Caso F, Costa L, Pagano VA, Frediani B, Manganelli S, Galeazzi M. Drug retention rates and treatment discontinuation among anti-TNF-alpha agents in psoriatic arthritis and ankylosing spondylitis in clinical practice. Mediators Inflamm. 2014;2014:862969.CrossRefPubMedPubMedCentral
Metadata
Title
Treatment patterns and costs for anti-TNFα biologic therapy in patients with psoriatic arthritis
Authors
Jacqueline B. Palmer
Yunfeng Li
Vivian Herrera
Minlei Liao
Melody Tran
Zafer E. Ozturk
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1102-z

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