Treatment Patterns and Pathways of Systemic Drug Therapy in Patients With Plaque, Erythrodermic, and Generalized Pustular Psoriasis

Systemic psoriasis treatment options have rapidly expanded in Japan, including the approval of tyrosine kinase 2 and interleukin-36 receptor inhibitors in 2022. However, contemporary real-world treatment patterns across plaque, erythrodermic, and generalized pustular psoriasis remain incompletely characterized. Using a Japanese hospital-based insurance claims database (Medical Data Vision Co. Ltd.), we conducted a retrospective cohort study for patients with these psoriasis subtypes who initiated systemic drug therapy between 2020-2023 and had a ≥ 12-month observation period. Overall, 3965 patients with plaque psoriasis, 80 with erythrodermic psoriasis, and 128 with generalized pustular psoriasis were included (median age, 62-66 years). Most patients initiated systemic therapy with a single drug. A phosphodiesterase 4 inhibitor was the most frequently prescribed index treatment for plaque psoriasis (48.8%), whereas a vitamin A derivative was most commonly prescribed for erythrodermic and generalized pustular psoriasis (42.5% and 42.2%, respectively), suggesting a distinctive Japan-specific prescription pattern. The median proportion of days covered for index treatment was nearly 100% across all subtypes. Among the index treatments, biologics generally showed longer time to discontinuation than oral medications. Elderly patients were more likely to receive a phosphodiesterase 4 inhibitor or a vitamin A derivative as index treatment than younger patients, and biologics were more commonly selected for patients with psoriatic arthritis than for those without. Early uptake of tyrosine kinase 2 inhibitor was observed in 2023. Over a median observation period of approximately 30 months, > 85% of patients received three or fewer lines of systemic drug therapy and approximately 50% remained on at least one systemic drug therapy throughout the study period. This first comprehensive Japanese claims database analysis of multiple psoriasis subtypes provides an updated real-world treatment landscape in Japan and helps address an important evidence gap arising from rapidly evolving systemic treatment options and limited contemporary real-world data.

Abstract from PubMed