Manish Patel’s research while affiliated with University of Illinois Chicago and other places

Background: Psoriatic patients often experience issues with lack of therapeutic efficacy and intolerance, which may result in high levels of treatment switching. This study examined real-world, 12-month switch rates and patient characteristics associated with treatment switching in patients with both PsO and PsA treated with risankizumab and other biologics. Methods: This analysis used the Merative MarketScan® Databases (2016–2024) to identify adults from the US who had ≥2 medical claims for PsO, 1 claim for PsA and did not have any other autoimmune condition in the 6 months pre- and post-index period. Patients must have initiated a PsO-approved biologic and have continuous insurance benefits for ≥6 months before and ≥12 months after the biologic initiation date. Switch rates were defined as the proportion of patients who switched to a new biologic or advanced oral in the 12-month follow-up after treatment initiation. Discontinuation and non-adherence were not included in the switch definition. Switch rates were compared between biologics with sufficient sample size (n 100). Univariate logistic regression analyses were conducted to compare switch rates for risankizumab versus other biologics. Multivariate logistic regression analyses were performed to examine the impact of baseline demographic and treatment characteristics on switch rates and determine predictors of switching. Results: Among 3032 patients, mean age at baseline was 47.4 (SD 10.78) years and 55.4% were female. Overall treatment switch rate at 12-month follow-up was 24.9% (756/3032). Of those treatments with sufficient sample size, patients receiving risankizumab had the lowest switch rate (7.3%; 15/206) compared to all other biologics, including other IL-23 inhibitors (guselkumab 16.7%, P=0.0029), IL-17 inhibitors (ixekizumab 22.4%, P<0.0001; secukinumab 23.7%, P<0.0001), TNF inhibitors (adalimumab 28.3%, P<0.0001; etanercept 35.8%, P<0.0001), and IL-12/23 inhibitors (ustekinumab 22.4%, P<0.0001). Results were similar in multivariate logistic regression analyses after adjusting for variations in baseline characteristics. Predictors of switching at 12 months included female sex (adjusted odds ratio [aOR] [95% CI]: 1.63 [1.36, 1.94]; P<0.0001), baseline anxiety or depression (aOR [95% CI]: 1.47 [1.21, 1.80]; P=0.0001), baseline major adverse cardiovascular event (aOR [95% CI]: 1.47 [1.15, 1.88]; P=0.0023), and prior targeted immunomodulator (TIM) use (aOR [95% CI]: 1.45 [1.20, 1.74]; P=0.0001). Conclusion: In a real-world setting, switching was common among psoriasis patients with PsA. Risankizumab showed the lowest rate of treatment switching at 12 months, compared with all other biologics. Sex, comorbidities, and prior TIM use were predictors of higher switch rates.

Despite advancements in the treatment of psoriasis (PsO), there are few head-to-head studies assessing comparative effectiveness of the newest therapies approved to treat PsO. Our objective was to assess the comparative clinical effectiveness of risankizumab and deucravacitinib in patients with moderate-to-severe PsO. This placebo-anchored matching-adjusted indirect comparison (MAIC) analysis utilized data from UltIMMa-1/2 risankizumab and POETYK PSO-1/2 deucravacitinib trials. Individual patient data from UltiMMA-1/2 were weighted via propensity score to match POETYK PSO-1/2 published summary data. Rate differences between risankizumab and deucravacitinib were assessed for Psoriasis Area and Severity Index (PASI) 75/90/100, the Static Physician Global Assessment (sPGA = 0 or 0/1), and the Dermatology Life Quality Index (DLQI) 0/1. At 16 weeks, risankizumab-treated patients demonstrated statistically significantly higher rates of skin clearance and greater improvement in quality of life (QoL) compared to those treated with deucravacitinib. Across all outcomes, risankizumab demonstrated a lower number needed to treat compared to deucravacitinib. Limitations are potential bias due to unobserved/unmeasurable differences and limited generalizability of the results. This indirect comparison demonstrates that risankizumab has higher rates of skin clearance and greater improvements in QoL than deucravacitinib. This study will help inform healthcare providers in their treatment and management strategy of PsO.

Background The impact of psoriasis in special areas (i.e., scalp, nails, palms, soles, genitals) on patient physical functioning, health-related quality of life (HRQoL), and work abilities has not been fully characterized. We assessed associations between disease severity and special area involvement in psoriasis symptoms, HRQoL, and work/activity impairment. Methods Patients with psoriasis from the CorEvitas Psoriasis Registry who initiated systemic treatment between 04/2015–06/2020 were included. Outcomes were change from baseline in psoriasis symptoms, Dermatology Life Quality Index (DLQI), and work/activity impairment at 6 months stratified by baseline disease severity and special area involvement. Results Among 2620 patients, increasing disease severity was associated with worsening patient-reported outcomes. Patients with (46.0%; N = 1205) versus without (54.0%; N = 1415) psoriasis in special areas reported greater HRQoL and work/activity impairment. Over 6 months, patients with unchanged or worsening disease severity had reduced HRQoL and increased symptom severity; incremental increases in patient HRQoL and decreases in symptom severity were associated with improved disease severity. Conclusions Higher disease severity and special area involvement was associated with worse outcomes and impaired work abilities. These data highlight the significant impact that adequate treatment of severe psoriasis and/or special area involvement may have on patient HRQoL and function.

Introduction: Psoriasis (PsO) is a chronic, inflammatory skin disorder that affects 1%–4% of adults in the US. While PsO typically affects the skin, it is also associated with other systemic comorbidities, such as psoriatic arthritis, cardiometabolic disease, diabetes, and obesity. Switching therapies is common in patients with PsO due to poor treatment outcomes, such as lack of efficacy or safety/tolerability issues that are notably more pronounced in refractory patients. This study aims to quantify real-world switch rates for patients with PsO treated with risankizumab, stratified by body mass index (BMI) categories. Methods: The Optum® Market Clarity data, which includes insurance claims linked with electronic medical records data, was used to identify biologic-naïve adult patients who initiated risankizumab between May 1, 2019 and September 30, 2022, with ≥1 PsO diagnosis (ICD codes) on or prior to biologic initiation. Patients had ≥6 months of continuous insurance benefits pre- and ≥12 months post-biologic initiation, and BMI data available on or in the 12 months before the start of risankizumab. Assessed outcomes included switch rates over 12 months among all risankizumab initiators and stratified by BMI category (BMI <25 Kg/m2, 25 to <30 Kg/m2, ≥30 Kg/m2). Results: A total of 367 patients were included in this analysis. The mean (SD) age of patients was 47.7 (14.3) years, 194 (52.9%) were female, 20 (5.5%) were Black, and 305 (83.1%) were White. Of all patients, 71 (19.4%) had a BMI of <25 Kg/m2, 111 (30.2%) had a BMI of 25 to <30 Kg/m2, and 185 (50.4%) had a BMI ≥30 Kg/m2. The switch rate by 12 months for all patients initiating risankizumab was 3.8%. Switch rates by BMI category were 5.6% (BMI <25 Kg/m2), 2.7% (BMI 25 to <30 Kg/m2), and 3.8% (BMI ≥30 Kg/m2); there were no significant differences in switch rates between BMI categories (P = 0.589 from Fisher's exact test). Conclusions: In this real-world study, treatment patterns through 12 months among patients initiating risankizumab were consistent regardless of BMI category.