title: Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population.
abstract: BACKGROUND
  Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population.
  
  
  OBJECTIVE
  We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab.
  
  
  METHODS
  We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting.
  
  
  RESULTS
  We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic.
  
  
  CONCLUSIONS
  Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data.
  
  
  CONCLUSIONS
  Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: jdoshi@mail.med.upenn.edu.
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Junko
authors.initials: J
authors.lastname: Takeshita
authors.affiliation: Amgen Inc, Thousand Oaks, California.
authors.forename: Lionel
authors.initials: L
authors.lastname: Pinto
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Penxiang
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Xinyan
authors.initials: X
authors.lastname: Yu
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Health Care Management and Economics, The Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Preethi
authors.initials: P
authors.lastname: Rao
authors.affiliation: Amgen Inc, Thousand Oaks, California.
authors.forename: Hema N
authors.initials: HN
authors.lastname: Viswanathan
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001688:Biological Products / Q000008:administration & dosage* / Q000494:pharmacology; D001691:Biological Therapy / Q000592:standards* / Q000639:trends; D016001:Confidence Intervals; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D020380:Needs Assessment; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D001688:Biological Products
keywords: Medicare; adalimumab; adherence; biologic; discontinuation; etanercept; infliximab; psoriasis; specialty drug; ustekinumab