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Journal of the American Academy of Dermatology
Volume 74, n° 6
page 1057 (juin 2016)
Doi : 10.1016/j.jaad.2016.01.048
accepted : 24 January 2016
Original Articles

Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

Jalpa A. Doshi, PhD a, c, , Junko Takeshita, MD, PhD b, d, Lionel Pinto, MS e, Penxiang Li, PhD a, c, Xinyan Yu, MD, MS a, c, Preethi Rao, MS c, f, Hema N. Viswanathan, PhD e, Joel M. Gelfand, MD, MSCE b, d
a Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
b Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
c Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
d Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
e Amgen Inc, Thousand Oaks, California 
f Health Care Management and Economics, The Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania 

Reprint requests: Jalpa A. Doshi, PhD, General Internal Medicine, University of Pennsylvania, Blockley Hall, Room 1223, 423 Guardian Dr, Philadelphia, PA 19104-6021.General Internal MedicineUniversity of PennsylvaniaBlockley Hall, Room 1223, 423 Guardian DrPhiladelphiaPA19104-6021

Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population.


We sought to investigate real-world utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab.


We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting.


We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic.


Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data.


Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.

The full text of this article is available in PDF format.

Key words : adalimumab, adherence, biologic, discontinuation, etanercept, infliximab, Medicare, psoriasis, specialty drug, ustekinumab

 Dr Yu is currently affiliated with IMS Health, Philadelphia, Pennsylvania. Dr Viswanathan is currently affiliated with Allergan plc, Irvine, California.
 Supported by funding from Amgen Inc. Dr Gelfand received salary support from National Institute of Arthritis and Musculoskeletal and Skin Diseases K24AR064310. Dr Takeshita received salary support from a Dermatology Foundation Career Development Award.
 Disclosure: Dr Doshi has served as a consultant and/or advisory board member for Alkermes Inc, Boehringer Ingelheim, Forest Laboratories, Merck, and Shire, receiving honoraria; had grants from Amgen Inc (relevant to this study), Humana Inc, Merck & Co Inc, Pfizer Inc, PhRMA, and National Pharmaceutical Council; and has a spouse who holds stocks in Merck & Co Inc and Pfizer Inc. Dr Takeshita has received grant funding from Pfizer Inc and received payment for CME work related to psoriasis. Mr Pinto is an employee of and shareholder of Amgen Inc. Dr Viswanathan was an employee and shareholder of Amgen Inc at the time of the study and is now an employee and shareholder of Allergan plc. Dr Gelfand served as a consultant for AbbVie, Amgen Inc, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Merck & Co Inc, Novartis Corp, and Pfizer Inc, receiving honoraria; had grants or has pending grants from AbbVie, Amgen Inc, Eli Lilly, Janssen Biologics, Novartis Corp, and Pfizer Inc; and received payment for CME work related to psoriasis. Dr Yu was an employee at the University of Pennsylvania at the time of the study; she is now an employee of IMS Health. Dr Li and Ms Rao have no conflicts to report.

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