Appendix Table II.
Multinomial logistic regression results for switchers, restarters, and other discontinuers of index biologic (compared with continuing users of index biologic)
| Switcher
|
Restarter
|
Other discontinuer
|
|||||||
|---|---|---|---|---|---|---|---|---|---|
| OR | 95% CI | P value | OR | 95% CI | P value | OR | 95% CI | P value | |
| Age category, y | |||||||||
| <65 | 1.84 | 1.13–3.00 | .014 | 1.50 | 0.95–2.35 | .079 | 1.21 | 0.90–1.62 | .207 |
| 65–69 | Ref | Ref | |||||||
| 70–74 | 1.52 | 0.92–2.51 | .106 | 0.96 | 0.59–1.56 | .863 | 1.26 | 0.93–1.70 | .130 |
| 75–79 | 0.79 | 0.36–1.72 | .547 | 1.42 | 0.79–2.54 | .240 | 1.71 | 1.19–2.46 | .004 |
| ≥80 | 0.77 | 0.35–1.70 | .513 | 1.34 | 0.73–2.47 | .341 | 1.70 | 1.16–2.49 | .006 |
| Sex, male | 0.64 | 0.47–0.88 | .005 | 0.96 | 0.72–1.27 | .764 | 0.70 | 0.58–0.84 | <.001 |
| Race | |||||||||
| White | Ref | Ref | |||||||
| Black | 1.27 | 0.71–2.29 | .417 | 1.05 | 0.59–1.88 | .860 | 1.10 | 0.75–1.60 | .639 |
| Hispanic | 1.03 | 0.45–2.37 | .944 | 0.79 | 0.36–1.72 | .549 | 0.74 | 0.42–1.28 | .275 |
| Other/unknown | 0.60 | 0.27–1.35 | .216 | 1.42 | 0.79–2.53 | .239 | 1.03 | 0.68–1.57 | .887 |
| Census region | |||||||||
| Northeast | Ref | Ref | |||||||
| Midwest | 0.67 | 0.41–1.10 | .113 | 0.52 | 0.33–0.81 | .004 | 0.72 | 0.52–0.99 | .045 |
| South | 0.78 | 0.49–1.25 | .307 | 0.59 | 0.39–0.89 | .012 | 1.08 | 0.80–1.45 | .634 |
| West | 0.89 | 0.54–1.46 | .637 | 0.52 | 0.32–0.82 | .006 | 0.89 | 0.64–1.23 | .485 |
| County-level characteristics | |||||||||
| Income, per capita, $10,000s | 1.02 | 0.83–1.25 | .850 | 0.91 | 0.76–1.09 | .300 | 0.94 | 0.83–1.07 | .357 |
| Dermatologists/10,000 residents | 1.04 | 0.54–1.99 | .916 | 1.42 | 0.80–2.53 | .234 | 1.08 | 0.73–1.61 | .704 |
| Low-income subsidy status | |||||||||
| Full | Ref | Ref | |||||||
| Partial | 0.77 | 0.17–3.42 | .726 | 1.88 | 0.67–5.29 | .233 | 2.68 | 1.35–5.35 | .005 |
| None | 1.50 | 0.92–2.45 | .109 | 1.72 | 1.08–2.75 | .022 | 2.25 | 1.66–3.05 | <.001 |
| Mixed (switched status) | 3.83 | 1.12–13.13 | .033 | 3.04 | 0.89–10.33 | .075 | 5.05 | 2.15–11.83 | <.001 |
| Drug benefit type | |||||||||
| Enhanced alternative | Ref | Ref | |||||||
| Basic alternative | 0.84 | 0.54–1.30 | .431 | 1.24 | 0.80–1.93 | .329 | 0.95 | 0.72–1.24 | .685 |
| Defined standard benefit | 0.51 | 0.26–1.00 | .051 | 1.09 | 0.58–2.08 | .785 | 0.94 | 0.62–1.44 | .775 |
| Actuarially equivalent standard | 0.71 | 0.43–1.17 | .179 | 1.34 | 0.82–2.20 | .248 | 1.22 | 0.89–1.67 | .219 |
| Unknown | 0.77 | 0.33–1.79 | .544 | 1.10 | 0.49–2.47 | .818 | 0.93 | 0.57–1.52 | .764 |
| Comorbidities | |||||||||
| Rheumatologic disease | 1.37 | 0.50–3.73 | .541 | 0.95 | 0.32–2.79 | .919 | 1.00 | 0.51–1.98 | .997 |
| Congestive heart failure | 0.70 | 0.35–1.41 | .313 | 1.01 | 0.61–1.69 | .959 | 1.07 | 0.75–1.52 | .711 |
| Diabetes | 0.82 | 0.57–1.17 | .273 | 1.24 | 0.89–1.73 | .196 | 1.06 | 0.86–1.32 | .574 |
| Dyslipidemia | 0.90 | 0.65–1.26 | .543 | 0.83 | 0.61–1.13 | .224 | 0.97 | 0.79–1.19 | .756 |
| Hypertension | 0.90 | 0.64–1.27 | .537 | 1.07 | 0.77–1.49 | .695 | 0.99 | 0.79–1.22 | .896 |
| Obesity | 1.13 | 0.71–1.78 | .616 | 1.09 | 0.71–1.66 | .695 | 1.06 | 0.79–1.42 | .714 |
| Atherosclerotic conditions | 1.29 | 0.83–2.00 | .258 | 1.66 | 1.14–2.41 | .008 | 1.16 | 0.90–1.51 | .257 |
| Liver disease | 1.43 | 0.84–2.43 | .187 | 1.00 | 0.58–1.72 | .999 | 1.33 | 0.94–1.88 | .109 |
| Dementia | 0.88 | 0.11–7.20 | .908 | 1.38 | 0.41–4.68 | .603 | 1.71 | 0.71–4.10 | .229 |
| Depression | 1.17 | 0.80–1.73 | .422 | 1.48 | 1.03–2.12 | .033 | 1.12 | 0.87–1.44 | .390 |
| Psoriatic arthritis | 0.92 | 0.64–1.33 | .656 | 0.94 | 0.67–1.33 | .743 | 0.77 | 0.62–0.97 | .027 |
| Renal disease | 1.13 | 0.63–2.01 | .692 | 1.07 | 0.65–1.76 | .792 | 0.83 | 0.59–1.18 | .310 |
| Immunosuppressive conditions | 0.97 | 0.47–1.97 | .925 | 1.09 | 0.59–2.02 | .785 | 1.23 | 0.83–1.81 | .306 |
| No. of 30-d supply equivalent prescriptions for nonpsoriasis medications | 1.00 | 0.95–1.05 | .933 | 0.97 | 0.92–1.01 | .136 | 0.96 | 0.93–0.99 | .011 |
| Mean RxHCC score | 0.96 | 0.68–1.35 | .792 | 1.07 | 0.78–1.46 | .694 | 1.23 | 1.00–1.52 | .056 |
| Index year | |||||||||
| 2010 | Ref | Ref | |||||||
| 2011 | 1.10 | 0.82–1.48 | .533 | 1.13 | 0.86–1.50 | .385 | 1.08 | 0.90–1.30 | .406 |
| Index biologic | |||||||||
| Etanercept | 7.48 | 2.97–18.82 | <.001 | 0.94 | 0.62–1.42 | .769 | 2.69 | 1.89–3.82 | <.001 |
| Infliximab | 3.20 | 1.11–9.19 | .031 | 0.83 | 0.48–1.44 | .509 | 1.72 | 1.12–2.66 | .014 |
| Ustekinumab | Ref | Ref | |||||||
| Adalimumab | 6.20 | 2.46–15.60 | <.001 | 0.54 | 0.35–0.82 | .004 | 2.04 | 1.43–2.90 | <.001 |
Switcher indicates patients beginning treatment with a new biologic within 90 d of discontinuing the index biologic. Restarter indicates patients resuming treatment with the index biologic or a new biologic after 90 d of discontinuing the index biologic. Other discontinuer indicates patients with discontinuation of index biologic and no resumption of treatment before the end of the follow-up period. Rheumatologic disease category excludes rheumatoid arthritis. Atherosclerotic conditions category includes cerebrovascular disease, myocardial infarction, and peripheral vascular disease. Immunosuppressive conditions include HIV/AIDS, cancer, and metastatic solid tumor.
CI, Confidence interval; Ref, reference group; RxHCC, prescription drug hierarchical condition category.