Philadelphia—Biologic therapies might offer better options for treatment of moderate to severe plaque psoriasis, but a substantial percentage of Medicare patients never realize the full benefits, according to a new study.

In fact, about half of Medicare patients who start taking infliximab, etanercept, adalimumab, or ustekinumab stop within a year, according to the report published recently in the Journal of the American Academy of Dermatology.

While previous studies have found similar results among the privately insured in the United States, the new study from University of Pennsylvania researchers is the first to focus on elderly and disabled patients who are covered under Medicare.

“Such suboptimal patterns of biologic use warrant further investigation, however our findings do suggest that high out-of-pocket costs under Medicare Part D are a potential factor,” said first author Jalpa A. Doshi, PhD, an associate professor of medicine at Penn.

For the study, researchers reviewed national Medicare claims data for patients with plaque psoriasis, and specifically, the 2,707 moderate-to-severe plaque psoriasis patients in the cohort who initiated treatment during 2010-2011 with the biologics—40% initiated adalimumab, 37.9% etanercept, 11.7% infliximab, and 10.3% ustekinumab.

Results indicate that patients’ use of biologics during the year following initiation was, on equivalent to medication coverage for only 61% of the days in that year.

While adherence was defined as 80% of days, only 38% of the psoriasis patients met that goal, according to the report. Of the nearly half of patients, 46%, who discontinued their medication during the year, only 8% switched to another biologic and 9% restarted biologic therapy after a gap of at least 90 days.

“Given that prior research has shown interruptions in biologic treatment for psoriasis to be associated with poorer outcomes compared to continuous therapy, understanding the reasons for treatment non-adherence is critical,” senior author Joel M. Gelfand, MD, MSCE, said in an American Academy of Dermatology press release.

Researchers suggested that higher out-of-pocket costs could be a factor in nonadherence. For example, they found that patients ineligible for subsidies under Medicare Part D were more likely to be nonadherent and discontinue their biologic treatment. Female patients also were more likely to be nonadherent.

“In addition, the analysis found differences in adherence depending on which biologic agent the patients were taking,” Doshi said, although low adherence and high discontinuation rates were observed for all four of the biologics.

“Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates,” study authors conclude. “Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.”

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