OBJECTIVES : Psoriatic arthritis (PsA) is an autoimmune condition associated with a debilitating impact on quality of life. This study evaluated treatment patterns among PsA patients prescribed biologics in the US Veterans Health Administration (VHA) population.

METHODS : Adult patients with ≥2 diagnosis for PsA treated with biologics (abatacept [ABT], adalimumab [ADA], brodalumab [BOD], certolizumab pegol [CZP], etanercept [ETN], golimumab [GOL], infliximab [IFX], ixekixumab [IXE], secukinumab [SEC], ustekinumab [UST]) during the identification period (01OCT2014-30SEP2018) were included. The first observed biologic claim was designated as first-line (1L) treatment (index biologic). Patients were excluded if they had any previous biologic claim 12 months prior to index biologic use; data were assessed until death or study end. The Charlson comorbidity index (CCI) score was determined. Change in line of treatment was defined as a switch to a non-index biologic or restart with the index biologic (restarted index biologic after the 60-day gap following run-out date of index biologic). A Sankey diagram was used to present the proportion of patients who transitioned to 2L and 3L treatment.

RESULTS : A total of 877 PsA patients who initiated 1L treatment were included. Mean age was 57.2 years, and 92.5% of patients were men. The mean CCI score was 1.1. Most PsA patients initiated ADA (52.1%), followed by ETN (34.8%), UST (5.8%), SEC (2.3%), IFX (1.9%), GOL (1.4%), CZP (0.9%), and ABT (0.8%) as 1L treatment. During the 2.5-year follow-up period, 483 (55.1%) patients transitioned to a 2L therapy and 228 (26.0%) transitioned to a 3L treatment. The most commonly-prescribed biologics across multiple treatment lines were ADA, ETN, and UST.

CONCLUSIONS : Sankey diagrams can reveal the trajectories of treatment for PsA patients over time and may help healthcare providers make informed decisions.