Abstract：
Although targeted immunomodulatory medications are increasingly utilized for inflammatory skin conditions like plaque psoriasis, little is known of the trends in the adoption of newly Federal Drug Administration (FDA)-approved immunomodulators by dermatologists. We performed a retrospective, cross-sectional analysis of Medicare Part D Prescriber datasets to identify dermatologists filing Medicare prescription claims for immunomodulatory drugs FDA-approved for plaque psoriasis between 2013 and 2018. Differences in dermatologist characteristics were determined between dermatologists prescribing a psoriasis treatment within two years of its FDA approval, \"early adopters\" and non-prescriber dermatologists over the same time period. Biologics approved for psoriasis from 2013 to 2018 included certolizumab pegol, secukinumab, brodalumab, ixekizumab, guselkumab, and apremilast. Early adopter dermatologists (n = 783) accounted for 5% of all Medicare Part D prescribing dermatologists. Early adopters were more likely to be male, in practice longer, and had a greater number of average annual beneficiaries than dermatologists who did not. Only six (< 1%) early adopters practiced in a small town or rural areas. We believe these data show that the adoption of novel biologic treatments for psoriasis by dermatologists to Medicare beneficiaries may be associated with clinician experience and practice volume. Additionally, we identified low absolute numbers of dermatologists prescribing biologics overall in non-metropolitan areas, which may represent delayed access to novel psoriasis treatments for many Medicare beneficiaries.
摘要：
尽管靶向免疫调节药物越来越多地用于炎性皮肤病，如斑块状牛皮癣，对于皮肤科医生采用新的联邦药物管理局（FDA）批准的免疫调节剂的趋势知之甚少。我们做了一个回顾,对MedicareD部分处方者数据集进行横断面分析,以确定皮肤科医生为2013年至2018年期间FDA批准治疗斑块型银屑病的免疫调节药物提交Medicare处方索赔.皮肤科医生特征的差异是在FDA批准两年内开出牛皮癣治疗处方的皮肤科医生之间确定的。“早期采用者”和非处方皮肤科医生在同一时期。2013年至2018年批准用于牛皮癣的生物制剂包括塞托珠单抗pegol，苏金单抗，Brodalumab,ixekizumab,guselkumab,和apremilast.早期采用皮肤科医生（n=783）占所有MedicareD部分处方皮肤科医生的5％。早期采用者更可能是男性，在实践中更长的时间，并且平均每年受益人数比没有的皮肤科医生多。只有六个（<1％）的早期采用者在小城镇或农村地区执业。我们相信，这些数据表明，皮肤科医生对Medicare受益人采用新型的牛皮癣生物治疗方法可能与临床医生的经验和实践量有关。此外,我们发现，在非大都市地区，皮肤科医生处方生物制剂的绝对数量总体较低，这可能代表许多医疗保险受益人延迟获得新型银屑病治疗。
