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 on 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 patients with psoriasis. Methods All adult patients with psoriasis registered in the French national health insurance database ('Systeme National des Donnees de Sante') between 2009 and 2017 were eligible for inclusion. The study population comprised apremilast- and methotrexate-naive patients, defined as those with a first prescription of apremilast or methotrexate. Levels of persistence were compared using a Cox model with propensity-score matching that included potential confounders (notably age, sex, psoriatic arthritis, comorbidities and previous exposure to topical and systemic treatments). Results In this nationwide population-based cohort, 14 147 adult patients with psoriasis (mean age 52 center dot 3 years, 55 center dot 2% male) were found to be naive to both apremilast and methotrexate. After propensity-score matching, two subgroups of 4805 patients with similar baseline characteristics were included, of whom 3207 apremilast-treated patients and 2736 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 patients when considering the study population as a whole (hazard ratio 1 center dot 28, 95% confidence interval 1 center dot 23-1 center dot 34) or in a propensity-score-matched analysis (hazard ratio 1 center dot 34, 95% confidence interval 1 center dot 27-1 center dot 41; P < 0 center dot 001). Conclusions Our real-world data suggest 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.