Variation in psoriasis treatment regimens comes at a price

Psoriasis is a chronic, immune-mediated skin disease that affects approximately 3% of the US population.1 Complications are common and treatment costs are high.

Credit: Ban – Austria –

A recent study estimated total direct costs per patient of $11,291, indirect costs of $2,101, patient out-of-pocket costs of $706, and lost productivity of approximately 14% over a 6-month period. rice field.2 Although topical therapy plays an important role in psoriasis treatment, it is often insufficient to obtain and maintain skin clearance, so phototherapy or systemic therapy are usually employed.3

A recent retrospective cohort study published in dermatological treatment journal We assessed actual treatment patterns and associated costs in psoriasis patients initiating systemic oral or biologic therapy.Four Treatment switching or discontinuation is common in psoriasis because of the chronic nature of the disease, variability in treatment response and drug safety profile, and the availability of multiple treatments.

This study evaluated switching, discontinuation, and non-switching patterns in two cohorts of psoriasis patients who initiated systemic therapy. Oral drugs (apremilast, cyclosporine, methotrexate, or acitretin) or biologics (etanercept, infliximab, ixekizumab, secukinumab, brodalumab, ustekinumab, guselkumab, adalimumab, certolizumab pegol, or tildrakizumab during the index period).

Patients who started multiple oral drugs or biologics on the index day or who had specific comorbidities such as rheumatoid arthritis or Crohn’s disease were excluded. The researchers evaluated treatment patterns in patients starting oral or biologic therapy separately.

In the oral cohort, 32% of patients discontinued their index treatment within 1 year of initiation, less than half (40%) remained on treatment, and 28% switched to another treatment, most often biologics. I switched. Among all oral therapies, apremilast had the highest persistence rate (41%) at his 1-year. Patients who started any of the remaining oral therapies had higher discontinuation rates and lower persistence rates.

The biologic cohort showed a higher persistence rate compared to the oral cohort, with 62% of patients remaining on index therapy during follow-up. About a quarter (23%) of patients switched to another therapy, usually another biologic, and 15% discontinued treatment.

Patients initiated with anti-interleukin agents were most likely to persist after 1 year, whereas patients initiated with antitumor necrosis factor had higher discontinuation rates, lower persistence rates, had the highest persistence rate. Switching within a biological cohort.

Post-switch costs were generally higher than pre-switch costs, regardless of cohort assignment. In the oral and biological cohorts, the total cost per month per patient within 1 year of initiation for non-switching, discontinuing, and switching patients was $2594, $1402, and $3956, respectively. $, $5035, $3112 and $5833. , Each. Notably, dose escalation was more common in biologic therapy than in oral therapy and may represent a therapeutic under-treatment within this cohort.

Overall, persistence was lower in the oral cohort than in the biological cohort, with more patients in the oral cohort discontinuing at 12 months than those in the biological cohort. This analysis suggests a pressing need for a safe and effective oral option for psoriasis patients to delay switching to costly biologic therapy.

About the author

Sabina Alikhanov Palmieri, PharmD, is a Clinical Pharmacy Specialist at the Community Health Network of Connecticut in Wallingford, Connecticut.


  1. Armstrong AW, Meta MD, Sup CW, Gond GC, Bell SJ, Griffith CEM. Prevalence of psoriasis in US adults. JAMA Dermatol. 1 August 2021;157(8):940-946. doi: 10.1001/jamadermatol.2021.2007. PMID: 34190957; PMCID: PMC8246333.
  2. Schaefer CP, Cappellelli JC, Cheng R, et al. Resource use, productivity, and costs for patients with moderate-to-severe plaque psoriasis in the United States. J Am Acad Dermatol. 2015;73(4):585–593.e583.
  3. Mentor A, Gelfand JM, Connor C, et al. Joint guidelines of the American Academy of Dermatology and the National Psoriasis Foundation for the management of psoriasis with systemic non-biologic therapies. J Am Acad Dermatol. 2020;82(6):1445-1486. ​​doi:10.1016/j.jaad.2020.02.044
  4. Sydney Thai, Joe Zhuo, Yichen Zhong, Qian Xia, Xiu Chen, Ying Bao, Devender Dhanda, Lawshia Priya & Jashin J. Wu (2023) Practical treatment patterns and Medical Expenses, Journal of Dermatology Treatment, 34:1, 2176708, DOI: 10.1080/09546634.2023.2176708

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