Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis.

IF 5.3 Q1 MEDICINE, RESEARCH & EXPERIMENTAL Biologics : Targets & Therapy Pub Date : 2023-10-04 eCollection Date: 2023-01-01 DOI:10.2147/BTT.S425693
Amir Haddad, Nili Stein, Idit Lavi, Lisa Shynkar, Irina Bergman, Ilan Feldhamer, Arnon Dov Cohen, Walid Saliba, Devy Zisman
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Abstract

Introduction: Persistence in drug therapy reflects treatment effectiveness and tolerability. We aim to estimate the persistence of apremilast prescribed to patients with psoriatic arthritis (PsA) and to identify characteristics associated with treatment discontinuation in a real-world setting.

Methods: Patients with PsA treated with apremilast from January 2016 were identified from a large health database and followed until medication stop date (using 3-months grace period), death or the end of observation period (June 2021). Demographic data, Charlson comorbidity index and concomitant and previous use of conventional and biologic DMARDs were extracted. The reasons for drug discontinuation were manually retrieved from patient charts. Time to discontinuation was estimated using survival analysis using Kaplan-Meier functions.

Results: Overall, 568 PsA patients treated with apremilast were identified. The mean age was 55.3±14.0 years, of whom 332 (58.5%) were females, 38.4% were obese (BMI>30), 75.2% had a Charlson comorbidity index>1, 24.1% were on concomitant treatment with methotrexate and 72.4% were biologic naïve. The median persistent period was 6.1,95% CI (5.2-6.9) months in which only 16.9% remained persistent on apremilast. No difference was found with regard to age, sex, socioeconomic status, ethnicity and obesity between patients who were persistent compared to patients who discontinued apremilast. Concomitant treatment with methotrexate and prior history of biologic therapy did not affect drug persistency (log rank P=0.957 and 0.082, respectively). Causes for treatment discontinuation were due to lack of skin efficacy in 19.4%, lack of joint efficacy in 33.3%, combined skin and joint inefficacy at 2.3% and due to side effects in 24.1%.

Conclusion: In this large observational retrospective cohort of patients treated with apremilast, a relatively low drug persistence was observed with 6-month and 1-year survival rates of 50.3% and 31.3%, respectively. Treatment discontinuation was mainly due to joint inefficacy, advocating for more studies for proper patient selection to assure treatment effectiveness and persistency.

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阿普利司特在银屑病关节炎患者中的治疗持续性。
引言:药物治疗的持续性反映了治疗的有效性和耐受性。我们的目的是评估为银屑病关节炎(PsA)患者开具的阿普司特的持续性,并确定在现实世界中与停药相关的特征。方法:从一个大型健康数据库中确定自2016年1月起接受阿普司特治疗的精神分裂症患者,并随访至停药日期(使用3个月的宽限期)、死亡或观察期结束(2021年6月)。提取人口统计学数据、Charlson共病指数以及常规和生物DMARD的伴随和既往使用情况。停药的原因是从病历中手动检索的。使用Kaplan-Meier函数进行生存分析,估计停药时间。结果:总共发现568例接受阿普司特治疗的精神分裂症患者。平均年龄为55.3±14.0岁,其中332(58.5%)为女性,38.4%为肥胖(BMI>30),75.2%的Charlson合并症指数>1,24.1%接受甲氨蝶呤联合治疗,72.4%为生物学幼稚。中位持续期为6.1,95%CI(5.2-6.9)个月,其中只有16.9%的患者在Apremast。在年龄、性别、社会经济地位、种族和肥胖方面,与停用阿普司特的患者相比,持续用药的患者没有发现差异。甲氨蝶呤联合治疗和既往生物治疗史不影响药物的持久性(log秩P分别为0.957和0.082)。停药的原因是缺乏皮肤疗效(19.4%)、缺乏关节疗效(33.3%)、皮肤和关节联合无效(2.3%)和副作用(24.1%),分别地治疗中断主要是由于关节无效,主张进行更多的研究以正确选择患者,以确保治疗的有效性和持续性。
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来源期刊
Biologics : Targets & Therapy
Biologics : Targets & Therapy MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
8.30
自引率
0.00%
发文量
22
审稿时长
16 weeks
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