Increasing Use of Systemic, Biologic Treatment for Psoriasis Observed Since 2007

Psoriasis, psoriatic skin disease, macro
Psoriasis, psoriatic skin disease, macro
At nearly a fifth of all patient visits for psoriasis, systemic agents are prescribed; biologic agents were the most frequently used for treatment.

The use of biologic and systemic agents for psoriasis treatment in the United States increased significantly from 2007 to 2016, according to study data published in the Journal of Dermatological Treatment.

Investigators abstracted data from the US National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. Conducted annually since 1989, the NAMCS captures patient visit data from ambulatory sites, including diagnostic codes, patient symptoms, and medication use. Visits for which the primary, secondary, or tertiary diagnosis was psoriasis were analyzed for mention of systemic or biologic medications. Systemic medications of interest included oral small molecule inhibitors, methotrexate acitretin, and apremilast; biologic agents of interest were etanercept, infliximab, adalimumab, certolizumab, ustekinumab, and secukinumab. The percentage of visits mentioning systemic or biologic treatment was computed across patient demographic groups and survey years. Logistic regression was used to assess trends in medication use over time. Analyses were weighted to produce nationally representative estimates.

Data from 20 (95% CI, 19-21) million office visits were assessed. The most commonly represented age strata were 40 to 49 years (19%; 95% CI, 15%-23%), 50 to 59 years (24%; 95% CI, 19%-28%), and 60 to 69 years (20%; 95% CI, 16%-24%). The majority of patients (92%; 95% CI, 85%-98%) were white, and 51% (95% CI, 45%-57%) were women. Systemic agents were prescribed 19% (95% CI, 15%-23%) of the time, corresponding to 3.9 (95% CI, 3.1-4.7) million visits. Biologic agents were prescribed for 13% (95% CI, 9.6%-17%) of visits, representing 2.6 (95% CI, 1.9-3.3) million visits. No significant differences in the use of systemic agents were observed by patient age (P =.3), race (P =.7), or sex (P =.2). Per bivariate logistic regression, the use of systemic agents increased during the study period (P =.002; R2 =.2) at an estimated rate of 15% (95% CI, 6%-24%) more visits per year. Biologic agent use increased by 17% (95% CI, 6%-29%) each year (P =.003; R2 = .3). On average, 59,000 (95% CI, 23000-94,000) more visits using systemic drugs were logged per year; for biologic agents, the yearly increase was 44,000 (95% CI, 16,000-75,000) visits. Of note, the use of methotrexate and oral small molecule inhibitors did not significantly change over time, although overall systemic medication use did.

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These data highlight the increasing use of systemic and biologic treatments for psoriasis in the United States. Investigators noted that newer biologic agents, such as secukinumab and ixekinumab, may have been approved too close to the end of the study period for usage trends to be properly assessed. In addition, NAMCS data do not include information on disease severity; prescribing trends may be different in patients with more severe disease. Further study with more recent NAMCS data is necessary to better elucidate medication use in patients with psoriasis.  

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Muddasani S, Fleischer AB Jr. United States systemic psoriasis treatments: increases in the use of biologic agents and plateau of methotrexate and oral small molecule inhibitors [published online February 20, 2020]. J Dermatolog Treat. doi:10.1080/09546634.2020.1729951