Use Of Biologic Agents In The Treatment Of Psoriasis: An Analysis Of The Quebec Provincial Drug Reimbursement Program Database


      The purpose of this study was to describe the use of biologics in the treatment of psoriasis, in a real life Canadian setting.


      A retrospective study of the Quebec provincial drug reimbursement program (RAMQ) was conducted using a random sample of patients who had received at least one diagnosis of psoriasis (ICD-9: 6961/6968/6969) and had used at least one biologic in the period from January 1, 2001 to August 31, 2011. Agents included in the study were adalimumab, etanercept, infliximab, abatacept, anakinra, efalizumab, golimumab, rituximab, tocilizumab and ustekinumab. The use of biologics was analyzed in terms of patient characteristics, treatment patterns and health care resource utilization.


      A total of 1382 patients who used at least one biologic were included in the study. The average age was 45,8 years (SD=15,0) and the proportion of men was slightly higher (53,5%). Most patients had other concomitant inflammatory diseases (80,8%), such as rheumatoid arthritis (48.6%), psoriatic arthritis (44.9%), and Crohn’s disease (15.0%). During the course of the study period, most patients used only one biologic (80.3%). Out of the 34,320 scripts for a biologic, 16,421 were for etanercept (47.9%), 8,868 for adalimumab (25.8%) and 7174 for infliximab (20.9%). Average annual cost for biologics in psoriasis was $19,026 and was slightly higher in the first year of treatment. Costs per patient of health care resource utilization in the year following the initiation of a biologic were $CAD486 lower than during the one year period preceding the biologic initiation; 45% of this reduction was associated with outpatient visits and 23% with hospitalizations.


      Psoriasis is associated with many other inflammatory conditions. Biologics use for the treatment of psoriasis has significantly increased over time. Although this is associated with higher medication costs, the initiation of a biologic is associated with a reduction of other medical costs.