Real-world psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database.

Background: Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.

Objectives: This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL) and anti-tumor necrosis factor (TNF) biologics.

Methods: The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months prior to index date, with 12‑month follow-up.

Results: In 2019, estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (n = 101) received index drug apremilast, 10.2% (n = 287) anti-IL, 6.8% (n = 191) anti-TNF, and 79.4% (n = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older, and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast versus anti-IL and anti-TNF groups (24.8% vs 59.6% and 53.9%; 36.6% vs 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast versus anti-IL and anti-TNF groups (4.95% vs 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% vs 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics versus apremilast, respectively, and the main driver for lower overall apremilast costs.

Conclusion: Given variation in treatment adherence/persistence, HCRU and costs between apremilast and biologics, these findings could be key considerations during treatment selection.