Kulikov A.Y., Makarova E.I. 339

Assessment of clinical and economic effectiveness of apremilast in the treatment of psoriatic arthritis

Psoriatic arthritis (PsA) can develop at any age and often affects the workingage population. In the course of the disease, physical activity of patients decreases, which leads to a drop in performance and absence from work due to treatment. If untreated, this can lead to disability and loss of function of the locomotive system structures. Strategy to combat PsA requires focus on the most effective prevention and control of both the progression of psoriasis, and arthritis associated therewith. It is equally important to minimize the risks associated with major organ toxicity and the development of side effects. In this context, the emergence of drugs for the treatment of psoriasis belonging to a new class of signaling pathways inhibitors seems to be highly relevant both from scientific and practical points of view. In general, biological products, which are antibodies that selectively bind to receptors or proteins on the extracellular membrane, block one biological marker (e.g., TNF-a, IL-17) participating in the immunopathogenesis of psoriasis, thus interrupting further inflammatory cascade of pathological processes leading to the formation of psoriatic efflorescence. Apremilast, which belongs to a new group of drugs - selective inhibitors of signaling pathways - has a fundamentally different mechanism of action. With targeted effect, the drug modulates intracellular signaling, eventually corresponding to the control of the expression of genes mediating key pro- and anti-inflammatory factors (e.g., release of cytokines) in myeloid, lymphoid and other cells involved in the “orchestration” of epidermis inflammation and hyperproliferation. The drug is administered orally, which eliminates additional costs for administering an injection, as is the case with biological drugs. The emergence of a new drug for the treatment of psoriatic arthritis, lack of proper control over the course of the disease, as well as limited healthcare system resources resulted in the pharmacoeconomic assessment of the priority drugs Apremilast compared to ustekinumab, adalimumab and infliximab using cost, cost-effectiveness and budget influence analysis methods. The cost analysis results showed that Apremilast treatment costs for the entire study period - 2 years - are on average 27% lower than the cost of treatment with ustekinumab, adalimumab and infliximab. Otezla treatment is characterized by a lower cost per unit of effectiveness - QALY, when considering the cost for the entire time horizon, as compared to Humira, Stelara and Remicade. Furthermore, the use of Apremilast leads to cost savings if administered for either 2 years or 1 year, in comparison with the alternative regimens.
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