Comparative Treatment Patterns Among Psoriasis Patients Using Adalimumab, Etanercept, or Ustekinumab

Objective: This retrospective study compared the treatment patterns of ustekinumab (UST), with recommended maintenance administration every 12 weeks, with adalimumab (ADA) and etanercept (ETA), administered weekly or every other week, for the treatment of plaque psoriasis. Methods: Persons with psoriasis >= 18 years and having >= 1 medical or pharmacy claim for UST or >= 1 pharmacy claim for ADA or ETA, from February 8, 2010, to January 31, 2011, were selected from the MarketScan databases and assigned to mutually exclusive cohorts. Patient characteristics and dose escalation were described during the 12- month pre- index period and 12- month follow- up period, respectively. Differences in baseline characteristics were adjusted using inverse probability of treatment weights. Pairwise comparisons of rates of discontinuations, restarts, and switches were made between ADA and UST and between ETA and UST. Results: A total of 2933 ADA, 4011 ETA, and 583 UST patients were selected. Patients in the UST cohort had higher baseline comorbidity scores and greater exposure to multiple psoriasis drugs at baseline. Dose escalation was observed in 7.8% of ADA patients, 30.9% of ETA patients, and 18.2% of UST patients. Discontinuations were seen in 38.6% of UST patients, 53.3% of ADA patients, and 56.2% of ETA patients. Restarts were seen in 8.9% of UST patients, 17.5% of ADA patients, and 23.1% of ETA patients. Switching to a nonindex medication occurred in 14.8% of UST patients compared with 22.0% of ETA patients and in 14.4% of UST patients compared with 20.8% of ADA patients. Conclusions: Discontinuations, restarts, and switches were common for all 3 biologics, but were significantly lower among patients with psoriasis receiving UST compared with those receiving ADA or ETA.