Persistence of apremilast in moderate-to-severe psoriasis. A real-world analysis of 14,147 apremilast- and methotrexate-naive patients in the French national health insurance database

BACKGROUND Real-world data towards the persistence of apremilast vs methotrexate are inconclusive.
OBJECTIVES To assess and compare the long-term persistence of apremilast and methotrexate in a large cohort of psoriatic patients.
METHODS All adult patients with psoriasis having been registered in the French national health insurance database ('Système National des Données de Santé', SNDS) between 2009 and 2017 were eligible for inclusion. The study population comprised apremilast- and methotrexate-naive patients, i.e. those with a first prescription of apremilast or methotrexate. Levels of persistence were compared using a Cox model with a propensity-score matching that included potential confounders (notably age; sex; psoriatic arthritis, co-morbidities, and previous exposure to topical and systemic treatments).
RESULTS In this nationwide population-based cohort, 14,147 psoriasis adult patients (mean age: 52.3; males: 55.2%) were found to be both apremilast- and methotrexate-naïve. After propensity score matching, two subgroups of 4,805 patients with similar baseline characteristics were constituted, but 3,207 apremilast-treated patients and 2,736 methotrexate-treated patients discontinued their treatment. Kaplan-Meier survival propensity-score analyses revealed a discontinuation rate of 69% for apremilast and 59% for methotrexate in the first year of treatment. Apremilast-treated patients had a higher risk of discontinuation than methotrexate-treated cohort patients when considering the study population as a whole (hazard ratio [95% confidence interval] = 1.28 [1.23-1.34]) or a propensity-score-matched analysis (1.34 [1.27-1.41]; p=<10 -4 ).
CONCLUSION Our real-world data suggested that in the first year of treatment, the discontinuation rate was significantly higher for apremilast-treated patients than for methotrexate-treated patients, regardless of the previous therapeutic lines received. This article is protected by copyright. All rights reserved.

as reported in: Br J Dermatol. 2019 Apr 25 [Epub ahead of print]