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A retrospective Medicaid data analysis notes delays in initiating disease-modifying anti-rheumatic drug therapy in Black vs. White patients with psoriatic arthritis. 

Psoriasis is an autoimmune disorder with highly varying presentations. Although skin lesions are present in most cases of psoriasis, epidemiological data suggests that 30% of those affected by psoriasis will ultimately develop psoriatic arthritis (PsA).

Treatment of PsA includes using non-steroidal anti-inflammatory drugs (NSAIDs), local glucocorticoid injections, and other medications for symptomatic relief. However, in the long run, disease-modifying antirheumatic drugs (DMARDs) are vital for managing the condition. There are many types of DMARDs in use, including conventional synthetic drugs (csDMARDs), like sulfasalazine, methotrexate, and others; newer oral targeted synthetic drugs (tsDMARDs), like tofacitinib, upadacitinib, and others; and a newer range of biologics (bDMARDs). 

Early initiation of therapy with DMARDs, particularly biologicals, can be life-changing for many. However, some studies suggest racial/ethnic disparities in healthcare delivery. This retrospective study, published in the journal Rheumatology and Therapy, aimed to quantify these inequalities.

Study Design 

The study used data for patients older than 18 years of age from the IBM MarketScan®Multi-state Medicaid Database, ranging from January 1, 2010 to December 31, 2019. Only patients who were continually enrolled in medical and pharmacy plans for 12 months or more after diagnosis and prior to the index date were included. This was vital since DMARDs are not prescribed immediately. The aim was to identify differences in the use of DMARDs based on race and ethnicity.

A total of 3,432 patients met the identification criteria. The study mainly focused on comparing healthcare delivery to White and Black patients since the sample size for other ethnicities was too small. Of the included patients, 77.4% were White and 10.1% were Black.

Time to Treatment Initiation Significantly Longer in Black vs. White Patients

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The results showed that fewer Black patients received any DMARD therapy (68.4 vs. 76.4%, respectively). Black patients were less likely to receive bDMARDs than White patients (33.6 vs. 42.6%). Additionally, it was noted that doctors tended to delay DMARD therapy in Black compared to White patients. 

Limitations and Future Directions

The use of claims data may have resulted in missing information on certain variables that impact treatment decisions, such as disease severity. Nevertheless, it can be safely assumed that individuals enrolled in Medicaid likely have similar socioeconomic backgrounds. Additionally, the study did not analyze state-level data, and therefore, treatment trends that may be influenced by state-level characteristics could not be determined. Finally, researchers noted that their findings are not generalizable to patients using non-Medicaid insurance claims. Nonetheless, this study could confirm racial disparities regarding psoriasis treatment, justifying more extensive studies in the future.

Source:

Patel, A., Ferrante, S., Lin, I., Fu, A. Z., Campbell, A., & Tieng, A. (2023). Racial and Ethnic Disparities in Treatment Initiation Among Patients with Newly Diagnosed Psoriatic Arthritis: A Retrospective Medicaid Claims Database Study. Rheumatology and Therapy, 10(5), 1241–1253. https://doi.org/10.1007/s40744-023-00580-y