Drug utilization and medication adherence for the treatment of psoriatic arthritis: an Italian study

Authors

  • Fiorenzo Santoleri Pescara General Hospital, Pescara - Italy https://orcid.org/0000-0002-9105-0745
  • Paolo Abrate Hospital Pharmacy of Ivrea, ASL TO4, Ivrea - Italy https://orcid.org/0000-0002-3394-3924
  • Laura Pestrin Hospital Pharmacy of Corato, Local Health Unit of Bari, Bari - Italy
  • Enrico Pasut Service of Pharmacy, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine - Italy https://orcid.org/0009-0006-8704-6694
  • Germana Modesti Service of Pharmacy, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine - Italy
  • Felice Musicco San Gallicano Dermatological Institute – IRCCS, Rome - Italy
  • Chiara Fulgenzio San Gallicano Dermatological Institute – IRCCS, Rome - Italy https://orcid.org/0000-0002-3569-9523
  • Eva Zuzolo San Gallicano Dermatological Institute – IRCCS, Rome - Italy https://orcid.org/0009-0002-9442-9299
  • Gabriella Pieri IRCCS Humanitas Research Hospital, Rozzano, Milan - Italy
  • Martina Roperti IRCCS Humanitas Research Hospital, Rozzano, Milan - Italy
  • Pietro Gazzola IRCCS Humanitas Research Hospital, Rozzano, Milan - Italy
  • Marco Gambera “Ospedale P. Pederzoli” Casa di Cura Privata S.p.A. Peschiera del Garda - Italy https://orcid.org/0009-0001-2424-9797
  • Isabella Martignoni “Ospedale P. Pederzoli” Casa di Cura Privata S.p.A. Peschiera del Garda - Italy https://orcid.org/0009-0004-4985-7942
  • Valentina Montresor “Ospedale P. Pederzoli” Casa di Cura Privata S.p.A. Peschiera del Garda - Italy
  • Francesca Guarino Chieti General Hospital, Chieti - Italy https://orcid.org/0009-0006-8370-3300
  • Laura Grossi Chieti General Hospital, Chieti - Italy
  • Letizia Di Fabio Vasto General Hospital, Vasto - Italy
  • Cristina Roberti Vasto General Hospital, Vasto - Italy
  • Concetta Spoltore Lanciano General Hospital, Lanciano - Italy
  • Gabriella Tinari Ortona General Hospital, Ortona - Italy
  • Stefania De Rosa Pharmacy Department ASL BAT, Bari-Andria-Trani - Italy
  • Romina Giannini Pharmacy Department ASL BAT, Bari-Andria-Trani - Italy
  • Roberto Langella Pharmacy Department, Agency for Health Protection (ATS) of Milan, Milan - Italy
  • Grazia Mingolla Brindisi General Hospital, Brindisi - Italy https://orcid.org/0009-0009-3944-4710
  • Mariantonietta Piccoli Brindisi General Hospital, Brindisi - Italy
  • Alberto Costantini Pescara General Hospital, Pescara - Italy

DOI:

https://doi.org/10.33393/grhta.2024.3204

Keywords:

Adherence, bDMARDs, Biosimilar, Persistence, Psoriatic arthritis

Abstract

Introduction: This study aims to evaluate the persistence, treatment adherence and drug cost associated with biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the management of psoriatic arthritis (PsA) in Italy, with a focus on biosimilar drugs.

Methods: This was a retrospective observational study involving eight hospital pharmacies, between January 2017 and December 2020, on naïve patients with at least one b/tsDMARD dispensation indicated for PsA. Patients were followed up for 12 months and persistence and adherence were evaluated by proportion of days covered (PDC). The originator and biosimilar for adalimumab and etanercept were compared. Furthermore, the real annual cost per patient based on adherence to therapy was calculated.

Results: Patients initiating b/tsDMARDs for PsA had a mean persistence of 263 days and 48.6% remained persistent for 1 year. Adherent patients (PDC ≥ 0.8) were 47.6% for the overall population. Similar persistence and adherence were observed between patients treated with the adalimumab originator and its biosimilar, while patients treated with the etanercept originator showed lower persistence and adherence compared to those treated with its biosimilar (mean persistence: 222 vs. 267 days, patient persistent at 1 year: 29.4% vs. 51.5%, mean PDC: 0.53 vs. 0.70, adherent patients: 23.5% vs. 51.5%). The average annual drug cost ranged from €8,724 (etanercept) to €14,783 (ustekinumab), with an annual saving of more than €2,500 by using biosimilars.

Conclusion: Poor adherence to medications contributes to suboptimal clinical outcomes. The comparison between biosimilar and originator offers further evidence in support of the biosimilar to optimizing resources in healthcare.

Downloads

Download data is not yet available.

References

Coates LC, Helliwell PS. Psoriatic arthritis: state of the art review. Clin Med (Lond). 2017;17(1):65-70. https://doi.org/10.7861/clinmedicine.17-1-65 PMID:28148584

Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am. 2015;41(4):545-568. https://doi.org/10.1016/j.rdc.2015.07.001 PMID:26476218

Gladman DD. Current concepts in psoriatic arthritis. Curr Opin Rheumatol. 2002;14(4):361-366. https://doi.org/10.1097/00002281-200207000-00005 PMID:12118168

Brockbank J, Gladman D. Diagnosis and management of psoriatic arthritis. Drugs. 2002;62(17):2447-2457. https://doi.org/10.2165/00003495-200262170-00004 PMID:12421102

Ibrahim G, Waxman R, Helliwell PS. The prevalence of psoriatic arthritis in people with psoriasis. Arthritis Rheum. 2009;61(10):1373-1378. https://doi.org/10.1002/art.24608 PMID:19790120

Khraishi M, Chouela E, Bejar M, et al. High prevalence of psoriatic arthritis in a cohort of patients with psoriasis seen in a dermatology practice. J Cutan Med Surg. 2012;16(2):122-127. https://doi.org/10.2310/7750.2011.10101 PMID:22513065

Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013;69(5):729-735. https://doi.org/10.1016/j.jaad.2013.07.023 PMID:23981683

D’Angelo S, Atzeni F, Benucci M, et al. Management of psoriatic arthritis: a consensus opinion by expert rheumatologists. Front Med (Lausanne). https://doi.org/10.3389/fmed.2023.1327931 PMID:38098852

Harrison SR, Aung Din BNR, Marzo-Ortega H, Helliwell PS. Recent advances in the management of psoriatic arthritis: practical considerations. Pol Arch Intern Med. 2024;134(1):16639; Epub ahead of print. PMID:38164520 https://doi.org/10.20452/pamw.16639 PMID:38164520

Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79(6):700-712. https://doi.org/10.1136/annrheumdis-2020-217159 PMID:32434812

Coates LC, Corp N, van der Windt DA, O’Sullivan D, Soriano ER, Kavanaugh A. GRAPPA treatment recommendations: 2021 update. J Rheumatol. 2022;49(6)(suppl 1):52-54. https://doi.org/10.3899/jrheum.211331 PMID:35293339

Chaudri NA. Adherence to long-term therapies evidence for action. Ann Saudi Med. 2004;24(3):221-222. https://doi.org/10.5144/0256-4947.2004.221

Haddad A, Gazitt T, Feldhamer I, et al. Treatment persistence of biologics among patients with psoriatic arthritis. Arthritis Res Ther. 2021;23(1):44. https://doi.org/10.1186/s13075-021-02417-x PMID:33514410

Murage MJ, Tongbram V, Feldman SR, et al. Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review. Patient Prefer Adherence. 2018;12:1483-1503. https://doi.org/10.2147/PPA.S167508 PMID:30174415

Smolen JS, Goncalves J, Quinn M, Benedetti F, Lee JY. Era of biosimilars in rheumatology: reshaping the healthcare environment. RMD Open. 2019;5(1):e000900. https://doi.org/10.1136/rmdopen-2019-000900 PMID:31245050

Yeaw J, Benner JS, Walt JG, Sian S, Smith DB. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009;15(9):728-740. https://doi.org/10.18553/jmcp.2009.15.9.728 PMID:19954264

Prieto-Merino D, Mulick A, Armstrong C, et al. Estimating proportion of days covered (PDC) using real-world online medicine suppliers’ datasets. J Pharm Policy Pract. 2021;14(1):113. https://doi.org/10.1186/s40545-021-00385-w PMID:34965882

Anghel LA, Farcaş AM, Oprean RN. Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. Patient Prefer Adherence. 2018;12:1151-1166. https://doi.org/10.2147/PPA.S165101 PMID:30013327

Oelke KR, Chambenoit O, Majjhoo AQ, Gray S, Higgins K, Hur P. Persistence and adherence of biologics in US patients with psoriatic arthritis: analyses from a claims database. J Comp Eff Res. 2019;8(8):607-621. https://doi.org/10.2217/cer-2019-0023 PMID:30912454

Walsh JA, Adejoro O, Chastek B, Palmer JB, Hur P. Treatment patterns among patients with psoriatic arthritis treated with a biologic in the United States: descriptive analyses from an administrative claims database. J Manag Care Spec Pharm. 2018;24(7):623-631; Epub ahead of print. https://doi.org/10.18553/jmcp.2018.24.7.623 PMID:29952704

Bonafede M, Fox KM, Watson C, Princic N, Gandra SR. Treatment patterns in the first year after initiating tumor necrosis factor blockers in real-world settings. Adv Ther. 2012;29(8):664-674. https://doi.org/10.1007/s12325-012-0037-5 PMID:22886712

Zhang HF, Gauthier G, Hiscock R, Curtis JR. Treatment patterns in psoriatic arthritis patients newly initiated on oral nonbiologic or biologic disease-modifying antirheumatic drugs. Arthritis Res Ther. 2014;16(4):420. https://doi.org/10.1186/s13075-014-0420-5 PMID:25146329

Zhu B, Edson-Heredia E, Gatz JL, Guo J, Shuler CL. Treatment patterns and health care costs for patients with psoriatic arthritis on biologic therapy: a retrospective cohort study. Clin Ther. 2013;35(9):1376-1385. https://doi.org/10.1016/j.clinthera.2013.07.328 PMID:23954091

Chastek B, White J, Van Voorhis D, Tang D, Stolshek BS. A retrospective cohort study comparing utilization and costs of biologic therapies and JAK inhibitor therapy across four common inflammatory indications in adult US managed care patients. Adv Ther. 2016;33(4):626-642. https://doi.org/10.1007/s12325-016-0312-y PMID:26970958

Sewerin P, Borchert K, Meise D, Schneider M, Mahlich J. Real-world treatment persistence with biologic disease-modifying antirheumatic drugs among German patients with psoriatic arthritis – a retrospective database study. Rheumatol Ther. 2021;8(1):483-497. https://doi.org/10.1007/s40744-021-00286-z PMID:33611778

Perrone V, Losi S, Filippi E, Sangiorgi D, Degli Esposti L. Pattern of drug use in patients with psoriatic arthritis in Italy: study in a real-world setting. Expert Rev Pharmacoecon Outcomes Res. 2021;21(4):721-727. https://doi.org/10.1080/14737167.2021.1880322 PMID:33472454

Rosenberg V, Chodick G, Xue Z, Faccin F, Amital H. Real-world data of adherence and drug survival of biologics in treatment-naïve and treatment-experienced adult patients with rheumatoid arthritis. Adv Ther. 2023;40(10):4504-4522. https://doi.org/10.1007/s12325-023-02607-w PMID:37566157

Murage MJ, Princic N, Park J, et al. Treatment patterns and health care costs among patients with psoriatic arthritis treated with biologic or targeted synthetic disease-modifying antirheumatic drugs. J Manag Care Spec Pharm. 2022;28(2):206-217.https://doi.org/10.18553/jmcp.2022.28.2.206 PMID:35098751

Menditto E, Cahir C, Malo S, et al. Persistence as a robust indicator of medication adherence-related quality and performance. Int J Environ Res Public Health. 2021;18(9):4872. Published 2021 May 3. https://doi.org/10.3390/ijerph18094872

Perrone V, Losi S, Filippi E, et al. Analysis of the pharmacoutilization of biological drugs in psoriatic arthritis patients: a real-world retrospective study among an Italian population. Rheumatol Ther. 2022;9(3):875-890. https://doi.org/10.1007/s40744-022-00440-1 PMID:35316515

Esposti LD, Perrone V, Sangiorgi D, et al. Analysis of drug utilization and health care resource consumption in patients with psoriasis and psoriatic arthritis before and after treatment with biological therapies. Biologics. 2018;12:151-158. https://doi.org/10.2147/BTT.S168691 PMID:30518996

Pina Vegas L, Penso L, Sbidian E, Claudepierre P. Influence of sex on the persistence of different classes of targeted therapies for psoriatic arthritis: a cohort study of 14 778 patients from the French health insurance database (SNDS). RMD Open. 2023;9(4):e003570. https://doi.org/10.1136/rmdopen-2023-003570 PMID:38114199

Lubrano E, Scriffignano S, Fatica M, et al. Psoriatic arthritis in males and females: differences and similarities. Rheumatol Ther. 2023;10(3):589-599. https://doi.org/10.1007/s40744-023-00535-3 PMID:36795290

Eder L, Thavaneswaran A, Chandran V, Gladman DD. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Ann Rheum Dis. 2013;72(4):578-582. https://doi.org/10.1136/annrheumdis-2012-201357 PMID:22589379

Kay J, Schoels MM, Dörner T, et al; Task Force on the Use of Biosimilars to Treat Rheumatological Diseases. Consensus-based recommendations for the use of biosimilars to treat rheumatological diseases. Ann Rheum Dis. 2018;77(2):165-174. https://doi.org/10.1136/annrheumdis-2017-211937 PMID:28866648

Fleischmann R. Editorial: the American College of Rheumatology white paper on biosimilars: it isn’t all white – there is some gray and black. Arthritis Rheumatol. 2018;70(3):323-325. https://doi.org/10.1002/art.40402 PMID:29411540

Larid G, Baudens G, Dandurand A, et al. Differential retention of adalimumab and etanercept biosimilars compared to originator treatments: results of a retrospective French multicenter study. Front Med (Lausanne). 2022;9:989514. https://doi.org/10.3389/fmed.2022.989514 PMID:36275803

Di Giuseppe D, Lindstrom U, Bower H, et al. Comparison of treatment retention of originator vs biosimilar products in clinical rheumatology practice in Sweden. Rheumatology (Oxford). 2022;61(9):3596-3605. https://doi.org/10.1093/rheumatology/keab933 PMID:34919663

van Adrichem RCS, Voorneveld HJE, Waverijn GJ, Kok MR, Bisoendial RJ. The non-medical switch from reference adalimumab to biosimilar adalimumab is highly successful in a large cohort of patients with stable inflammatory rheumatic joint diseases: a real-life observational study. Rheumatol Ther. 2022;9(4):1109-1118 https://doi.org/10.1007/s40744-022-00465-6 PMID:35655028

Blauvelt A, Leonardi CL, Gaylis N, et al. Treatment with SDZ-ADL, an adalimumab biosimilar, in patients with rheumatoid arthritis, psoriasis, or psoriatic arthritis: results of patient-reported outcome measures from two phase III studies (ADMYRA and ADACCESS). BioDrugs. 2021;35(2):229-238. https://doi.org/10.1007/s40259-021-00470-1 PMID:33651341

Schmalzing M, Kellner H, Askari A, et al. Real-world effectiveness and safety of SDZ ETN, an etanercept biosimilar, in patients with rheumatic diseases: final results from multi-country COMPACT study. Adv Ther. 2024 Jan;41(1):315-330. https://doi.org/10.1007/s12325-023-02706-8 PMID:37950790

Pinto AS, Cunha MM, Pinheiro F, et al. Effectiveness and safety of original and biosimilar etanercept (Enbrel® vs Benepali®) in bDMARD-naïve patients in a real-world cohort of Portugal. ARP Rheumatol. 2022 Apr-Jun;1(2):109-116. English. PMID: 35810368.

Agenzia Italiana del Farmaco. Secondo Position Paper AIFA sui Farmaci Biosimilari 27 Marzo 2018. https://www.aifa.gov.it/en/farmaci-biosimilari. Accessed July 2024.

Addis A. Biosimilari: l’Agenzia Italiana del Farmaco prende posizione [Biosimilars: Italian Medicines Agency takes position.]. Recenti Prog Med. 2018 Apr;109(4):214-215. Italian. https://doi.org/10.1701/2896.29191. PMID: 29689035.

Belhassen M, Tubach F, Hudry C, et al. Impact of persistence with tumour necrosis factor inhibitors on healthcare resource utilization and costs in chronic inflammatory joint diseases. Br J Clin Pharmacol. 2021;87(1):163-177. https://doi.org/10.1111/bcp.14387 PMID:32441383

Zagni E, Frassi M, Mariano GP, et al. A real-world economic analysis of biologic therapies for psoriatic arthritis in Italy: results of the CHRONOS observational longitudinal study. BMC Health Serv Res. 2022;22(1):1537. https://doi.org/10.1186/s12913-022-08954-8 PMID:36527051

Degli Esposti L, Perrone V, Sangiorgi D, et al. Therapeutic strategies utilization and resource consumption in patients treated for psoriatic arthritis: findings from a real-world analysis in an Italian setting. Patient Prefer Adherence. 2019;13:187-194. Published 2019 Jan 22. https://doi.org/10.2147/PPA.S178603

Perrone V, Giacomini E, Sangiorgi D, et al. Treatment pattern analysis and health-care resource consumption on patients with psoriatic arthritis or ankylosing spondylitis treated with biological drugs in a northern Italian region. Ther Clin Risk Manag. 2020;16:509-521. https://doi.org/10.2147/TCRM.S248390 PMID:32606710

Car E, Vulto AG, Houdenhoven MV, Huys I, Simoens S. Biosimilar competition in European markets of TNF-alpha inhibitors: a comparative analysis of pricing, market share and utilization trends. Front Pharmacol. 2023;14:1151764. Published 2023 Apr 21. https://doi.org/10.3389/fphar.2023.1151764

Rojas-Giménez M, Mena-Vázquez N, Romero-Barco CM, et al. Effectiveness, safety and economic analysis of Benepali in clinical practice. Reumatol Clin (Engl Ed). 2021;17(10):588-594. https://doi.org/10.1016/j.reumae.2020.06.010 PMID:34823826

Published

2024-10-09

How to Cite

Santoleri, F., Abrate, P., Pestrin, L., Pasut, E., Modesti, G., Musicco, F., Fulgenzio, C., Zuzolo, E., Pieri, G., Roperti, M., Gazzola, P., Gambera, M., Martignoni, I., Montresor, V., Guarino, F., Grossi, L., Di Fabio, L., Roberti, C., Spoltore, C., Tinari, G., De Rosa, S., Giannini, R., Langella, R., Mingolla, G., Piccoli, M., & Costantini, A. (2024). Drug utilization and medication adherence for the treatment of psoriatic arthritis: an Italian study. Global and Regional Health Technology Assessment, 11(1), 191–199. https://doi.org/10.33393/grhta.2024.3204

Issue

Section

Original Research Articles
Received 2024-07-15
Accepted 2024-09-09
Published 2024-10-09

Metrics