Biologic Dose Adjustments Influence Cost of Therapy for Psoriasis Patients

Alexander Egeberg, MD, PhD

A new investigation from Sweden suggested that dose adjustments for biologic treatments in psoriasis could have significant influence on cost and cost-effectiveness for affected patients.

Though the clinical and economic implications of dose adjustments have been acknowledged, actual evidence regarding these adjustments in real-world treatment of psoriasis has been lacking.

Additionally, limited real-world data suggests that biologic efficacy is reduced in many patients at doses that were established in clinical trials, which could result in a worsening of symptoms and a myriad of comorbidities.

Utilizing national Swedish registries, an investigative team led by Alexander Egeberg, MD, PhD, Department of Dermatology at Bispebjerg Hospital, analyzed the use of biologics for psoriasis in real-world practice with an interest in dose adjustments and the implications on cost.

The observational, longitudinal cohort study utilized data on adults with moderate to severe psoriasis from 3 Swedish national registries between 2010 and 2018. Patients with psoriatic arthritis in the registries were excluded.

Eight distinct biologics including adalimumab, etanercept, secukinumab, and ustekinumab were featured in the registry data, and investigators only included treatment groups that had 50 or more patients.

Most treatments suggested a higher dose for the initial induction followed by a maintenance period, and the dosing of most biologics were not adjusted for body weight, except for ustekinumab. Investigators only acknowledged the first treatment episode of a specific biologic when considering dosing.

After careful consideration, the team identified 178,347 patients with psoriasis and/or psoriatic arthritis between 2005 and 2018. The primary analysis would feature 2292 patients.

Overall, the average dose for all biologics featured in the investigation was above recommended levels.

Specifically, the average weighted doses for adalimumab , etanercept, secukinumab, and ustekinumab were higher than SmPC recommendations over the treatment period by 13%, 23%, 8%, and 3%, respectively.

Naturally, higher doses translated to higher costs, with significant increases over time versus expected costs for secukinumab specifically.

During a cost analysis, investigators determined that adalimumab had the lowest cost of dose increments while etanercept had the highest.

“Our study demonstrates that dose adjustments over time are frequent for biologics in clinical practice,” the team wrote. “The overall increases in dose above recommendations for all the biologics analyzed have economic consequences with relevance to the cost and cost-effectiveness of the individual therapies.”

In their closing remarks, Egeberg and colleagues suggested that future research could study why physicians would choose to increase dosing – which as the study suggested, influenced cost- rather than switching treatments.

The study, "Real-world dose adjustments of biologic treatments in psoriasis and their economic impact – a Swedish national population study," was published online in Clinical and Experimental Dermatology.