Adherence to Apremilast Treatment for Psoriasis Similar Regardless of Method of Visit

To assess the adherence of use between psoriasis (PsO) and psoriatic arthritis (PsA) patients prescribed apremilast through in-person visits compared to telehealth visits during the COVID-19 pandemic, researchers conducted a retrospective cohort study using databases from October 1, 2019, to December 31, 2020.¹

RFBSIP/AdobeStock

Das et al reviewed claims data from the Merative MarketScan Commercial and Medicare Supplemental databases, with the index date being the date for the first claim for apremilast during the identification period. Researchers used the period from April 1, 2019, to June 30, 2019, as a benchmark for pre-pandemic treatment patterns.

Study outcomes were adherence, which was measured as the proportion of days covered (PDC) during the follow-up period,and persistence to apremilast treatment. Full adherence was defined as PDC of at least .80. Persistence of therapy was considered as continuous use from the index date “to the end of available days’ supply of apremilast therapy without a gap” of more than 60 days.

Of the 505 patients with PsO or PsA who began treatment with apremilast between April 1, 2020, and June 30, 2020, 141 patients began treatment via a telehealth appointment and 364 patients via an in-person visit. The mean age between cohorts was similar, 46.8 years for the telehealth group and 48 years for the in-person group (P = .304). Females comprised 61.7% of the telehealth cohort compared with 56.3% females in the in-person cohort, and the cohorts had similar comorbidities at baseline.

At the index visit, 28.4% of patients in the telehealth group visited a rheumatologist compared to 12.1% of patients in the in-person group. “A significantly higher proportion of patients in the telehealth cohort received non-apremilast systemic therapy during the baseline period compared to the in-person cohort (36.2% vs. 22.3%, respectively; P = 0.001). During baseline, higher proportions of patients in the telehealth cohort had systemic non-biologic (18.4% vs. 10.4%, respectively; P = 0.015) as well as systemic biologic (22.7% vs. 13.5%, respectively; P = 0.011) therapy use.”

During the 6-month follow-up period, patients in the 2 cohorts had similar mean PDC. Full adherence was also similar between cohorts, with 49.6% for the telehealth cohort and 56% for the in-person cohort. The proportion of patients initiating apremilast via telehealth showed similar persistence to those beginning treatment in-person (62.4% vs. 66.2%, respectively; P = 0.422). Similar findings were observed in the pre-pandemic benchmark period.

“A telehealth visit at index was more likely among younger patients (OR 0.98, 95% CI 0.96–1.00; P = 0.025), patients visiting a rheumatologist (OR 2.27, 95% CI 1.10–4.68; P = 0.027), and patients with any baseline telehealth visit compared to their counterparts (OR 1.91, 95% CI 1.20–3.04; P = 0.007).” Older patients and those diagnosed with PsO were more likely to be fully adherent to treatment.

Das et al concluded that apremilast treatment for PsO and PsA can be managed effectively through telehealth visits, although additional research needs to be done to assess the impact of other clinical and treatment factors.

Reference

1. Das AK, Chang E, Paydar C, et al. Apremilast adherence and persistence in patients with psoriasis and psoriatic arthritis in the telehealth setting versus the in-person setting during the COVID-19 pandemic. Dermatol Ther (Heidelb) 13,1973–1984(2023). https://doi.org/10.1007/s13555-023-00967-3