Mapping the road to biologics in psoriasis and psoriatic arthritis: A nationwide drug utilization study

Abstract Background Limited research has been conducted on whether advances in novel biologics and biosimilars have improved the treatment journey preceding biologics. Objectives To map the overall treatment journey preceding the initiation of first biologic therapy in patients with psoriasis (PsO) and psoriatic arthritis (PsA), as well as the changes over time. Methods Using Danish nationwide registries, we included all patients treated with a first‐time biologic (2010–2018) for either PsO or PsA and reported the medical treatment journey. We used Sankey diagrams to illustrate the flow of treatment series. Results The study included 2082 patients with PsO (62.5% male) and 1831 patients with PsA (42.3% male). Before biologics, 49.5% treated for PsO and 36.8% treated for PsA received ≥2 type therapies and 59.3% with PsO and 25.5% with PsA received ≥3 treatment series. Median time from first systemic therapy to a biologic was 3.9 years (Q1–Q3, 1.3–4.1) for PsO and 2.1 years (Q1–Q3, 0.6–5.8) for PsA. The majority of patients with PsO (1174 [56.4%]) received multiple treatment series with the same drug, while almost a third of patients with PsA (572 [31.2%]) did the same. Twelve percent of patients with PsO and 6.4% of patients with PsA repeated treatment with a drug they had already stopped for an alternative treatment. Conclusions Although most patients are adequately managed, our findings suggest the possibility of a yet too long and complicated treatment journey before starting biologics.