April 28, 2021
New Spherix Global Insights’ Patient Audit Highlights Key Differences Between Dermatologists’ and Rheumatologists’ Management of Psoriatic Arthritis, Focusing on Patients Recently Switched Between Advanced Systemic Treatment Brands
US dermatologists report increased confidence in treating psoriatic arthritis patients without a rheumatologist, and the two specialist groups report different drivers behind key treatment decisions in patient management
EXTON, Pa., April 28, 2021 /PRNewswire/ – The past five or so years have seen a flurry of US biologic approvals for the treatment of psoriasis (PSO), resulting in an era of unprecedented efficacy for the management of moderate to severe disease. Many of these more targeted next generation PSO biologics (Novartis’ Cosentyx, Eli Lilly’s Taltz, Janssen’s Tremfya) have demonstrated efficacy in not only skin clearance, but also for improving issues with joints – ultimately expanding their FDA approved labeling to include the treatment of psoriatic arthritis (PsA).
As such, dermatologist’s biologic armamentarium now closely parallels that of rheumatologists. With many psoriasis patients eventually progressing to include joint involvement, managing joint pain has become more top of mind. Most dermatologists now report they are more confident in their ability to manage joint pain and PsA without a rheumatologist than in the past, with a sizeable subset further agreeing they hold onto PsA patients for longer periods of time.
Spherix has been tracking the rheumatologist-treated switch segment of the PsA market through their RealWorld Dynamix™: Biologic/Small Molecule Switching in PsA (US) service for the last six years. The 2021 rheumatology update captured chart records of 1,022 PsA patients who have been switched from one biologic or small molecule to another brand within the past three months (provided by 203 US rheumatologists).
However, with US dermatologists increasingly managing PsA patients, Spherix has expanded their RealWorld Dynamix™ offerings in 2021 in an effort to uncover key dynamics contrasting the two treating specialists. The inaugural audit included in RealWorld Dynamix™: Biologic/Small Molecule Switching in PsA – Dermatology Perspective (US) captures the records of 510 PsA patients supplied by 157 treating dermatologists and provides an opportunity to uncover key differences in the US switch market between the two treating specialties.
PsA patients currently treated by dermatologists have less severe forms of PsA than those treated by rheumatologists (as judged by overall PsA severity classification, number of swollen joints, and key laboratory measures, among other information). While the overall psoriasis severity assessed by the two physician groups is comparable, dermatologist-treated patients have higher BSA, PASI scores, and a greater number of difficult-to-treat areas of the body impacted, implying rheumatologists are not as focused on these measures when assessing PSO severity.
Indeed, and perhaps as a result of the degree of joint versus skin involvement, the level of co-management between the two specialties also varies. More than double the percent of dermatologist-treated patients are equally co-managed with a rheumatologist than those co-managed under a rheumatologist’s care. In addition, substantially more rheumatologists report they made the decision to switch the patients without input from the dermatologist than the converse.
Other key differences include the parameters involving the recent patient switch itself: the reason behind why a switch was initiated, the drivers behind new brand selection, and the specific winning and losing of brands in the US PsA switch market. Perhaps unsurprisingly, significantly more rheumatologist-treated patients were switched primarily due to issues involving joint efficacy on the prior brand, while in contrast, dermatologist-treated PsA patients were most often driven to switch brands due to issues regarding skin clearance.
Of note, however, is that efficacy in joints was also a strong driving force behind dermatologist-treated patient switches, though skin efficacy is significantly less prioritized as a key switching driver among rheumatologist-treated patients. Likewise, when selecting the new switch to brand, metrics related to skin efficacy were more pronounced amongst dermatologists, whereas joint efficacy was a greater driving force behind the new brand choice for rheumatologists.
Other key discrepancies are uncovered when examining the specific brands that PsA patients were recently switched from and to. Specifically, dermatologists report substantially greater use of Amgen’s Otezla in earlier lines of PsA therapy than rheumatologists, however, both specialties recently switched an equal percentage of PsA patients to the oral PDE4 inhibitor. PsA patients treated by rheumatologists are also significantly more likely to be treated with a TNF-inhibitor (AbbVie’s Humira, Amgen’s Enbrel, UCB’s Cimzia, Janssen’s Remicade or an infliximab biosimilar) or JAK-inhibitor (Pfizer’s Xeljanz or off-label use of AbbVie’s Rinvoq), regardless of line of therapy or switch-from/switch-to status, than those treated by a dermatologist.
Finally, dermatologist-treated PsA patients were more than four times more likely to be switched to an IL-23 inhibitor (Tremfya or off-label use of AbbVie’s Skyrizi) than those treated by a rheumatologist and were also significantly more likely to be switched to an IL-17 inhibitor (Cosentyx or Taltz) than those managed by rheumatologists. Of note, use of Janssen’s Stelara and BMS’ Orencia is comparable between the two specialties in both the switch-from and switch-to settings.
One thing that is evident regardless of the treating specialist, is that the newest AMOA classes – the IL-17 and IL-23 inhibitors – left the most on the table when switching occurred. In other words, they were most often in the running to garner the recent switch but were ultimately passed over. Reasons these brands were passed on are further explored in the audit and are key metrics for understanding the driving forces behind the dynamic PsA switching market.
About RealWorld Dynamix™
RealWorld Dynamix™ is an independent, data-driven service unveiling real patient management patterns through rigorous analysis of large-scale patient chart audits. Insights reveal the “why” behind treatment decisions, include year over year trending to quantify key aspects of market evolution, and integrate specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns. Learn more about our services here.
About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select dermatology, gastroenterology, nephrology, neurology, and rheumatology markets.
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