Trends in Biologic, Oral Systemic, and Phototherapy Use in Patients With Psoriasis, Psoriatic Arthritis

Real-world utilization of biologics for the treatment of psoriasis and psoriatic arthritis reveals interesting trends and surprising practices, finds an analysis.

Biologics use increased, oral retinoids use decreased, and oral immunosuppressants and phototherapy plateaued for the treatment of psoriasis and psoriatic arthritis (PsA) from 2001 to 2015 in the United States according to study research published in the Journal of the American Academy of Dermatology.

In the study, researchers sought to characterize the utilization trends of biologics, oral immunosuppressants, acitretin, phototherapy, and systemic corticosteroids (SCS) in US patients with psoriasis and/or PsA. Data from the 2001-2015 National Ambulatory Medical Care Survey, a cross-sectional sample of US office-based physician visits, were analyzed during 5-year intervals using logistic regression. A weighted total of 33,600,000 patient visits for psoriasis were recorded from 2001 to 2015; 95.7% of these patients were adults, of whom 49.6% were women.

In the visits for psoriasis/PsA, dermatologists used systemic therapy 20.9% of the time, most commonly with biologics (8%), followed by oral immunosuppressants (5.0%), SCS (3.5%), and phototherapy (3.3%). Specifically, from 2001 to 2005 and 2011 to 2015, the use of biologics for the treatment of psoriasis and psoriatic arthritis increased at patient visits from 3.8% (range, 1.5%-9.6%) to 13.1% (range, 10.0%-16.9%, P =.01). In that same time period, treatment with oral retinoid use decreased from 4.5% (range, 1.9%-7.0%) to 1.7% (range, 0.3%-3.0%, P =.05), whereas use of oral immunosuppressants (P ≥.24) and phototherapy (P ≥.06) plateaued. Although SCS are not in the psoriasis treatment guidelines or recommended for the chronic management of PsA, SCS use increased in metropolitan areas from 2001 to 2005 to the time period 2011 to 2015 (1.7% [range, 0%-3.6%] to 5.6% [range, 2.5%-8.7%], P =.15).

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Study limitations include lack of data on psoriasis severity and individual longitudinal treatment course.

Significant treatment variation exists among specialists managing psoriasis and/or PsA, with increasing use of biologics over time, the researchers noted.

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Singh P, Silverberg JI. Real-world trends in biologic, oral systemic and phototherapy in United States patients with psoriasis or psoriatic arthritis [published online January 28, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.01.045