(376) Real-world persistence of first-line advanced therapies in patients with psoriatic arthritis

Background: : Advanced therapies such as interleukin (IL)-23, IL-12/23, IL-17, phosphodiesterase-4 (PDE-4), and tumor necrosis factor (TNF) inhibitors (i) have been approved for first-line treatment of active psoriatic arthritis (PsA). Risankizumab (RZB), an IL-23i, was approved for the treatment of PsA in the US on 1/21/22. Real-world evidence on treatment persistence for PsA does not fully include recently approved therapies.

Objective: : This study evaluated real-world persistence in patients with PsA initiating first-line advanced therapies (1LAT) over 12 months.

Methods: : Adults with ≥1 PsA diagnosis at baseline who initiated a new 1LAT between 1/21/22 and 10/31/24 were identified using the MerativeTM Marketscan® databases covering 1/1/16 to 10/31/24 and ≥6 months of continuous enrollment pre-index date (baseline) and ≥12 months of continuous enrollment post-index date. Persistence was defined as no treatment switch or discontinuation. Treatment switch was defined as a claim for a different 1LAT after the index date; treatment discontinuation was defined as a gap in treatment without refill equal to 90 days of the assumed days of supply of the last prescription fill. Multivariate logistic regression was used to compare persistence rates among individual drugs (reference: RZB), accounting for differences in baseline characteristics.

Results: : A total of 2181 patients met the inclusion criteria for the study and were treated with adalimumab (ADA; n = 600), apremilast (APR; n=577), etanercept (ETN; n=147), golimumab (GOL; n=70); guselkumab (GUS; n =221), ixekizumab (IXE; n =163), risankizumab (RZB; n=266), secukinumab (SEC; n =137). Switch rates varied across 1LAT from 5.3% to 30.7% and discontinuation rates varied from 21.8% to 53.2%, with RZB having the lowest switch and discontinuation rates within 12 months following treatment initiation. Persistence rates were the highest for RZB (76.3%) followed by SEC (65.7%), GUS (61.1%), ETN (59.2%), GOL (52.9%), IXE (52.8%), ADA (49.2%) and APR (41.6%). Compared with RZB, the odds of persistence were SEC 0.63 (95% CI 0.40-0.99), GUS 0.50 (95% CI 0.34-0.74), ETN 0.48 (95% CI 0.30-0.74), GOL 0.38 (95% CI 0.22-0.67), IXE 0.35 (95% CI 0.23-0.54), ADA 0.31 (95% CI 0.22-0.44), and APR 0.23 (95% CI 0.17-0.32), all P< 0.05.

Conclusions: : In this real-world US claims data study of adults with PsA initiating 1LAT, persistence rates at 12 months were significantly higher with RZB relative to all other treatments.

Sponsorship:: AbbVie