Background Etanercept (ETN), adalimumab (ADA), and infliximab (INF) are the 3 most frequently prescribed tumor necrosis factor (TNF)-blocker therapies that are approved by the US Food & Drug Administration for treatment of moderate to severe rheumatoid arthritis (RA). Clinical guidelines and published studies do not offer clear recommendations for treatment options after discontinuing a TNF-blocker for RA. Treatment patterns after TNF-blocker discontinuation have not been well characterized.
Objectives To estimate the proportion, among RA patients enrolled in US managed care plans, who discontinued their index (initial) TNF-blocker treatment (ETN, ADA, or INF), who subsequently restarted their index TNF-blocker or switched to another biologic or nonbiologic therapy.
Methods The IMS LifeLink™ Health Plan Claims database was used to identify RA patients who received ETN, ADA, or INF between 1 January 2005 and 31 March 2009. Patients with psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, or juvenile idiopathic arthritis during the 180 days prior to index TNF-blocker therapy were excluded. Patients were considered discontinued from index TNF-blocker therapy upon switch to a non-index TNF-blocker therapy for RA or >45-day gap in index TNF-blocker therapy. The index date was the date of switch or the first day of 45-day gap, whichever came first. Patients had to be continuously enrolled in the health plan and were followed for 360 days after index date; study end date was 31 March 2010. Patients were categorized into mutually exclusive groups, in descending order, based on whether they: 1) restarted their index TNF-blocker, 2) switched to another TNF-blocker (ETN, ADA, or INF), 3) switched to other biologics, 4) switched to a non-biologic therapy, or 5) had no new treatment.
Results Among an initial 18094 RA patients who were on TNF-blocker therapy, 9952 RA patients (5155 ETN; 2513 ADA; 2284 INF) discontinued treatment, met selection criteria, and were included in this analysis. Mean age at discontinuation was 49.5 yrs; 76.6% were women. Within 360 days of discontinuing a TNF-blocker, 52.2% of patients restarted their index TNF-blocker (59.5% of ETN; 45.2% of ADA; 43.1% of INF; p<0.001 for ADA and INF vs ETN; 61-66% restarted within the first 3 months); 16.5% switched to another TNF-blocker (16.5% from ETN; 19.2% from ADA; 13.8% from INF); 5.7% switched to other biologics (2.7% from ETN; 5.4% from ADA; 12.7% from INF); 5.4% switched to a non-biologic therapy (4.7% from ETN; 6.0% from ADA; 6.5% from INF); and 20.2% had no new treatment (16.6% from ETN; 24.2% from ADA; 23.8% from INF).
Conclusions TNF-blocker restarts occurred frequently after discontinuation of index TNF-blocker therapy, suggesting that long gaps (>45 days) in TNF-blocker therapy may be common practice among RA patients. A significantly higher proportion of ETN patients restarted their index TNF-blocker within 1 year of discontinuation compared with ADA and INF patients. After discontinuation of index TNF-blocker therapy, 19% of ETN patients, 25% of ADA patients, and 27% of INF patients switched to another TNF-blocker or other biologic therapy.
This study sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. and by Wyeth, which was acquired by Pfizer Inc.
Disclosure of Interest V. Schabert Consultant for: Amgen Inc., K. Fox Consultant for: Amgen Inc., C. Watson Shareholder of: Amgen Inc., Employee of: Amgen Inc., J. Yeaw Consultant for: Amgen Inc., S. Goodman Consultant for: Amgen Inc., S. Gandra Shareholder of: Amgen Inc., Employee of: Amgen Inc.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.