According to a poster abstract by Wu et al presented at Maui Derm Connect 2021, dose escalation (DE) was significantly lower with one IL-23 inhibitor vs all other available biologics for the treatment of moderate to severe plaque psoriasis.
The study aimed to compare the real-world DE in the maintenance period among biologic therapies. Data were collected from IBM MarketScan Research Database, an administrative claims database that includes fee-for-service, preferred provider organizations, capitated, and Medicare supplemental health plans, between 2018 and 2020.
The study population included adult patients who had at least two medical claims for psoriasis based on ICD-9 or ICD-10 codes; at least three claims of an index biologic in the maintenance period; at least 6 months of treatment duration of the index biologic in the maintenance period between April 23, 2019, and August 31, 2020; and at least 6 months of continuous enrollment pre- and post-start of the maintenance period (ie, first maintenance claim of the biologic).
For analysis, the researchers calculated the percentage of patients who had a DE during the first 6 months of maintenance, with DE defined as two or more dosing intervals in which the average daily dose was at least 20% higher than the expected daily dose. An additional sensitivity analysis was conducted based on at least a 30% higher than expected dose. DE was compared between a newer IL-23 inhibitor, risankizumab, and other biologics using chi-square tests. Logistic regression, adjusted for age, gender, region, Charlson Comorbidity Index, and previous targeted immunomodulator use, were used for adjusted comparisons.
In total, 1611 patients were included in the analysis. Among this population, the percentage of patients with DE using the 20% and 30% thresholds was significantly lower in patients who received risankizumab than those who received other biologics, including the classes of TNF inhibitors, IL-17 inhibitors, other IL-23 inhibitors, and IL-12/23 inhibitors. After adjustment for baseline characteristics, this result remained consistent.
“Patients with [psoriasis] treated with risankizumab demonstrated reliable dosing,” stated the study authors. “Dose escalation may significantly increase the cost of treatment for patients with moderate to severe psoriasis…Longer-term real-world evidence is warranted in future studies to evaluate the impact of durability of response on dosing patterns.”
Reference
Wu JJ, Patel M, Gao W, Photowala H, Garg V, Crowley J. Real-world dose escalation of biologics for patients with moderate to severe psoriasis. Poster presented at: Maui Derm Connect; January 25-29, 2021; Maui, HI.
