Real-World Treatment Patterns, Healthcare Resource Utilisation, and Costs in Biologic-Naïve Patients with Moderate-to-Severe Psoriasis Treated with Biologics in France

INTRODUCTION: Real-world evidence investigating treatment patterns and associated economic outcomes in patients with psoriasis (PsO) are lacking. This study evaluated treatment patterns, healthcare resource utilisation (HCRU), and costs in biologic-naïve patients with moderate-to-severe PsO initiating biologics in France. METHODS: Biologic-naïve adults with moderate-to-severe PsO initiating an anti-tumour necrosis factor (TNFα) or anti-interleukin (IL) biologic were identified from the Système National des Données de Santé. Switching and dose escalation rates, calculated using Kaplan-Meier analyses, were assessed over 42 months of follow-up. HCRU and costs were assessed during the 12 months following initiation. Comparisons between switchers/non-switchers and dose escalators/non-dose escalators were conducted using Wilcoxon rank sum, chi-square, and Fisher exact tests. RESULTS: Overall, 20,995 biologic-naïve adult patients initiating a biologic were included in the analysis. At 42 months, switch rates and dose escalation rates were lowest for patients initiating anti-IL-23 agents and highest for anti-TNFα agents. Specifically, the lowest rate of switching (15.0%) and dose escalation (9.0%) were observed for patients treated with the anti-IL-23 agent risankizumab. The mean number of total healthcare visits at 12 months was significantly (p < 0.001) higher for treatment switchers versus non-switchers (48.8 vs 39.0) and dose escalators versus non-dose escalators (47.4 vs 39.9). Furthermore, switchers had significantly (p < 0.001) higher mean medical (€3435 vs €2578), inpatient (€1126 vs €826), outpatient (€1751 vs €1331), and pharmacy (€13,105 vs €10,589) costs versus non-switchers. Similar trends were observed for dose escalators versus non-dose escalators (€3453 vs €2638; €965 vs €870; €1682 vs €1371; and €13,736 vs €10,683, respectively, p < 0.001). CONCLUSION: Anti-IL-23 agents demonstrated the lowest rates of switching and dose escalation over 42 months, whilst anti-TNFα agents had the highest rates. More specifically, the lowest rates were observed for patients treated with risankizumab. Overall, higher rates of switching or dose escalation corresponded with higher HCRU and costs.