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Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis

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. METHO...

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Autores principales: Haddad, Amir, Stein, Nili, Lavi, Idit, Shynkar, Lisa, Bergman, Irina, Feldhamer, Ilan, Cohen, Arnon Dov, Saliba, Walid, Zisman, Devy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10560465/
https://www.ncbi.nlm.nih.gov/pubmed/37814674
http://dx.doi.org/10.2147/BTT.S425693
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author Haddad, Amir
Stein, Nili
Lavi, Idit
Shynkar, Lisa
Bergman, Irina
Feldhamer, Ilan
Cohen, Arnon Dov
Saliba, Walid
Zisman, Devy
author_facet Haddad, Amir
Stein, Nili
Lavi, Idit
Shynkar, Lisa
Bergman, Irina
Feldhamer, Ilan
Cohen, Arnon Dov
Saliba, Walid
Zisman, Devy
author_sort Haddad, Amir
collection PubMed
description 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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spelling pubmed-105604652023-10-09 Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis Haddad, Amir Stein, Nili Lavi, Idit Shynkar, Lisa Bergman, Irina Feldhamer, Ilan Cohen, Arnon Dov Saliba, Walid Zisman, Devy Biologics Original Research 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. Dove 2023-10-04 /pmc/articles/PMC10560465/ /pubmed/37814674 http://dx.doi.org/10.2147/BTT.S425693 Text en © 2023 Haddad et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Haddad, Amir
Stein, Nili
Lavi, Idit
Shynkar, Lisa
Bergman, Irina
Feldhamer, Ilan
Cohen, Arnon Dov
Saliba, Walid
Zisman, Devy
Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis
title Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis
title_full Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis
title_fullStr Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis
title_full_unstemmed Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis
title_short Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis
title_sort treatment persistence of apremilast among patients with psoriatic arthritis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10560465/
https://www.ncbi.nlm.nih.gov/pubmed/37814674
http://dx.doi.org/10.2147/BTT.S425693
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