Biologic initiation rates in systemic-naive psoriasis patients after first-line apremilast versus methotrexate use

<b>Aim:</b> To compare rates of biologic initiation after commencing treatment with apremilast (APR) versus methotrexate (MTX) in systemic-naive patients with psoriasis (PsO). <b>Methods:</b> This was a retrospective cohort study of systemic-naive patients with PsO who initiated treatment with APR or MTX between 1 January 2015 and 31 March 2018. <b>Outcomes:</b> Adjusted rates of biologic initiation during follow-up were compared by logistic and Cox regressions. <b>Results:</b> APR initiators had 58% lower likelihood of biologic initiation (odds ratio: 0.42; 95% CI: 0.37-0.48; p < 0.001), lower adjusted biologic initiation rate (14.4% [95% CI: 13.2-15.7%] vs 28.6% [95% CI: 26.8-30.5%]), lower risk of biologic initiation (hazard ratio: 0.45; 95% CI: 0.40-0.51; p < 0.001) compared with MTX initiators. <b>Conclusion:</b> Systemic-naive patients with PsO have a lower rate of biologic initiation over 1 year following APR initiation.