Low Apremilast Persistence May Hinder Remission, Recovery Among Patients with PsA

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Findings from a retrospective cohort study of patients with psoriatic arthritis (PsA) prescribed apremilast are calling attention to a lack of treatment persistence with the agent.

Among more than 500 patients with PsA taking apremilast, treatment persistence was 50.3% at 6 months and 31.3% at 1 year, independent of age, sex, socioeconomic status, ethnicity, and obesity.¹

“As there are now more PsA treatment options available on the market, it is becoming more crucial to describe treatment persistence from actual experience because it helps clinicians make more informed decisions about the best therapeutic options for PsA patients in order to maximize symptom remission, promote functional recovery and lower health-care costs,” wrote investigators.¹

Although there is no cure for PsA, a growing range of treatments are available to help slow disease progression, lessen pain, protect joints, and preserve range of motion.² Symptoms can be lifelong, ranging from mild to severe, and may disappear entirely between flares. Treatment helps patients manage symptoms, but persistence may affect their impact.³

To assess the persistence of apremilast use among patients with PsA and identify characteristics associated with treatment discontinuation, a team of investigators led by Amir Haddad, MD, rheumatologist at Carmel Medical Center in Israel, collected electronic health record data from Clalit Health Services database for patients > 18 years of age, diagnosed with PsA, and prescribed apremilast as indicated for PsA under the Israeli National Healthcare Drug Plan. In total, 568 participants were identified and followed until medication stop date, death, or the end of the observation period in June 2021.¹

The mean age of the study population was 55.3 (Standard deviation, 14.0) years, of whom 58.5% were females, 38.4% were obese, 75.2% had a Charlson comorbidity index > 1, 24.1% were on concomitant treatment with methotrexate, and 72.4% were biologic naïve. Investigators considered participants non-persistent if 90 days passed without a prescription refill. Causes of treatment discontinuation for apremilast were manually retrieved by reviewing each patient’s medical record in the database.¹

Investigators estimated time to treatment discontinuation using Kaplan–Meier curves and compared results among patient subgroups. Baseline characteristics between persistent and non-persistent patients were also compared using the chi-square test for categorical variables and the independent samples t-test for continuous variables.¹

Among the cohort, the median persistent period was 6.1 (95% Confidence interval [CI], 5.2-6.9) months, during which 19.9% of participants remained persistent on apremilast. Investigators pointed out treatment persistency was not affected by concomitant treatment with methotrexate (log-rank P = .957) and prior history of biologic therapy (log-rank P = .082).¹

Further analysis revealed causes for treatment discontinuation were:

• Lack of skin efficacy (19.4%)
• Lack of joint efficacy (33.3%)
• Combined skin and joint inefficacy (2.3%)
• Side effects (23.9%)

Of note, age, sex, socioeconomic status, ethnicity, and obesity were not associated with apremilast persistence among the cohort.¹

“This dataset provides the largest real-world investigation on the use of apremilast in PsA published to date, providing an accurate representation of drug treatment patterns and persistence in real-life circumstances,” concluded investigators.¹

References:

1. Haddad A, Stein N, Lavi I, et al. Treatment Persistence of Apremilast Among Patients with Psoriatic Arthritis. Biologics. 2023;17:129-136. Published 2023 Oct 4. doi:10.2147/BTT.S425693
2. National Psoriasis Foundation. About Psoriatic Arthritis. September 29, 2023. Accessed October 17, 2023. https://www.psoriasis.org/about-psoriatic-arthritis/
3. Cleveland Clinic. Psoriatic Arthritis. Diseases & Conditions. Accessed October 17, 2023. https://my.clevelandclinic.org/health/diseases/13286-psoriatic-arthritis