Comparing Compliance Rates of Atopic Dermatitis Patients on Systemic Medications With Those of Psoriasis Patients on Systemic Medications: A National Retrospective Study Using the Veterans Affairs Database
Reid Waldman, MD, University of Connecticut, Farmington
Disclosures: None.
Importance
The management of moderate to severe atopic dermatitis (AD) is being revolutionized by the development of novel systemic therapeutics. However, these new therapeutics are being implemented using the same treatment paradigms that are used for psoriasis treatment (ie, patients on systemic medications require indefinite therapy). While use of systemic therapeutics indefinitely is acceptable to many psoriasis patients because psoriasis severity is frequently stable over long periods of time, AD is hallmarked by seasonal flares followed by periods of relative quiescence, making indefinite therapy less attractive to patients with AD.
Objective
This whole-population cohort study describes systemic medication adherence patterns in AD and psoriasis patients. These patterns are then compared to determine whether systemic medications requiring indefinite therapy are adhered to at similar rates in the AD and psoriasis populations. The aim of this comparison is to assess whether drugs requiring indefinite therapy meet the needs of AD patients requiring systemic treatment.
Design, Setting, and Participants
This is a retrospective cohort study using the national Veterans Administration (VA) health database to identify all veterans with psoriasis and AD who are receiving care at any VA location. Veterans with psoriasis and AD were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes. Veterans were included in the study if they received nonsteroidal systemic immunosuppressive or immunomodulatory medications for their psoriasis or AD.
Main Outcome(s) and Measure(s)
All medications filled at a VA pharmacy are time stamped. This unique data recording allows for real-world adherence to be evaluated by comparing actual medication fill dates to expected medication fill dates based on refill interval. Patients who fill a medication more than 7 days after the expected refill date are classified as nonadherent. We described systemic medication adherence rates and assessed for seasonal variation in adherence patterns for AD and psoriasis patients. Cofounding variables, including history of mental illness, substance use disorder, and patient income, were recorded and included in the analysis.
Conclusions and Relevance
This study's unique data source provides insight into the ways adherence patterns differ between individuals with AD and psoriasis, and insights into the ways mental illness, substance use, and poverty affect adherence to systemic therapeutics among dermatology patients with inflammatory skin conditions.