(98) Real-world treatment patterns in patients with psoriasis receiving tildrakizumab compared to ustekinumab

Background: : There is limited real-world data comparing treatment patterns of patients with moderate-to-severe psoriasis receiving tildrakizumab (TIL) vs. ustekinumab (UST).

Objective: : This study examined real-world treatment patterns of patients initiating TIL or UST from April 2018 to June 2023 using IQVIA PharMetrics Plus claims data.

Methods: : Time to treatment discontinuation (TTD) was defined as time to first gap of ≥3x days’ supply between consecutive claims or between last claim and end of follow-up, accounting for censoring using Kaplan-Meier analysis. Days’ supply was sourced from claims data, or imputed using package insert dosing schedules if unavailable in claims. Persistence was defined as proportion of patients on treatment at 12 and 24 months after treatment initiation, adherence as having proportion of days covered ≥80% while on treatment, and switching/reinitiation as proportion of patients with ≥2 consecutive claims for any biologic on or after TIL/UST discontinuation (among those who discontinued). TTD was compared using Cox proportional hazards models and adherence and switching/reinitiating using logistic regression models. Comparative models were adjusted for key baseline characteristics.

Results: : Of 338 patients on TIL (mean follow-up: 19.4 months; mean age at index: 48.5 years; female: 46.7%) and 5738 on UST (follow-up: 25.9 months; age at index: 46.7 years; female: 52.1%), median TTD (95% confidence interval [CI]) was 21.7 (14.7, 29.7) months (TIL) and 11.2 (10.6, 11.9) months (UST). Persistence on TIL and UST was 65.7% and 48.3% at 12 months and 44.8% and 33.3% at 24 months, respectively. Patients on TIL had 37% lower adjusted hazard of discontinuation vs those on UST (hazard ratio [95% CI]: 0.63 [0.53, 0.76]; P < 0.001). Proportions of adherent patients were 69.8% (TIL) and 62.7% (UST). Patients on TIL had 48% higher adjusted odds of being adherent vs those on UST (odds ratio [OR; 95% CI]: 1.48 [1.16, 1.90]; P = 0.002). Proportions of patients who discontinued were 38.5% (TIL) and 57.8% (UST). Of those, 46.2% (TIL) and 24.5% (UST) did not switch to a different biologic or reinitiate index treatment. Patients on TIL had 2.46 times higher adjusted odds of having no biologic treatment after discontinuation vs those on UST (OR: 2.46 [1.70, 3.56]; P < 0.001).

Conclusions: : These findings highlight TIL’s favorable treatment patterns over UST, with significantly longer persistence and higher adherence. These results support TIL as an effective treatment for managing moderate-to-severe psoriasis.

Sponsorship:: Sun Pharma.