Apremilast vs Methotrexate Biologic Initiation Rates in Systemic-Naive Psoriasis

Among systemic-naive patients with psoriasis who began treatment with apremilast or methotrexate, researchers sought to compare rates of biologic initiation.

In systemic-naive patients with psoriasis (PsO) who began treatment with apremilast (APR) or methotrexate (MTX), patients on APR experienced a delay in biologic initiation over the next year, according to study results published in the Journal of Comparative Effectiveness Research. In the follow-up period, among patients initiating a biologic agent, patients previously treated with APR saw longer time to biologic initiation than those previously treated with MTX.

Among systemic-naive patients with PsO who began treatment with APR or MTX, researchers sought to compare rates of biologic initiation.

To accomplish this, they conducted a retrospective cohort study of claims data from the IBM® MarketScan® Commercial and Medicare Supplemental databases from 2014 to 2019 of systematic-naive patients with PsO whose treatment with APR (n=3288; 49.2±12.9 years of age; 53.9%women) or MTX (n=2572; 49.5±13.2 years of age; 55.1% women) started from December 2014 to April 2018.

Those patients whose treatment began with APR saw a 58% lower likelihood of biologic initiation (odds ratio: 0.42; 95% CI, 0.37–0.48; P <.001), lower adjusted biologic initiation rate (14.4% [95% CI, 13.2–15.7%] vs 28.6% [95% CI, 26.8–30.5%]), and lower risk of biologic initiation (hazard ratio: 0.45; 95% CI, 0.40–0.51; P <.001) compared with those patients whose treatment began with MTX.

Study limitations include the retrospective observational analysis design, lack of control of confounding variables, the MTX cohort may have had more severe disease than the APR cohort, data included medication prescription not medication adherence, and the inclusion only of patients with commercial and Medicare supplemental insurance.

Researchers concluded that, “In adults with primary commercial or Medicare supplemental insurance, systemic-naive patients with PsO on APR had a delay in biologic initiation compared with patients on MTX.” During the 1-year follow-up, among patients beginning a biologic agent, the APR users saw time to biologic initiation that was longer than MTX users. Researchers went on to say, “APR use may delay biologic initiation in patients with PsO, suggesting better symptom control and outcome relative to MTX.”

Disclosure: This research was supported by Amgen, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Kaplan D, Husni E, Chang E, et al. Biologic initiation rates in systemic-naive psoriasis patients after first-line apremilast versus methotrexate use. J Comp Eff Res. June 2022; 11(8):575-582. doi:10.2217/cer-2021-0311