Background Reports suggest that a large proportion of patients who acquire and use biologic DMARD agents (biologics) to treat Rheumatoid Arthritis (RA) do not acquire or adequately consume traditional DMARDs (DMARDs)(1,2). However acquisition rates of biologics and DMARDs at the point of biologic initiation remains to be determined.
Objectives Exploration of the level of DMARD acquisitions in Canadian RA patients in the 6 to 12 months both immediately prior to and post-biologic initiation to quantify the levels of biologic monotherapy vs. biologic + DMARD combination consumption.
Methods Biologic and DMARD concomitant therapy based on actual patient purchases was examined by tracking a cohort of 1,652 anonymous RA patient records from public and private drug plans in Canada (ON, QC) via unique drug plan identifier numbers (3rd party source).(3) All patients who were initiated on a biologic between August 2009 and July 2010 were tracked for a one-year period prior to and post their biologic initiation date. All cohort patients were compliant on biologics post initiation. Rheumatologist prescribing frequencies of RA therapies were assessed through randomly recruited surveys (n=100).(4)
Results Physicians prescribed a biologic without a DMARD only 12% of the time(4). 25% of cohort patients did not purchase any form of DMARD within the 6 months prior to starting a biologic (41% for MTX). 29% did not acquire DMARDs at any point in the 6 months post-biologic initiation (43% for MTX). Data 12 months pre-biologic initiation showed that 22% did not acquire DMARDs (37% for MTX). Data 12 months post-biologic initiation showed that 26% did not acquire DMARDs (41% for MTX).(3) Prescriptions supplied to 2-3 months worth of drug.(4)
Conclusions A large proportion of Canadian patients do not acquire any form of DMARD in the 6-12 months prior to being initiated on a biologic for the first time. This may negatively influence compliance on DMARDs once a biologic is initiated. Registries suggest this, as 6 months post-biologic initiation, 29% do not acquire any form of DMARD (43% for MTX) despite the general physician prescribing rate of biologic monotherapy (12%).(3,4) These results are consistent with other registries, however this study isolates biologic monotherapy levels immediately prior to and post-biologic initiation.(1,2,3) Many patients report reluctance or refusal to take DMARDs due to side effects that include headache, GI discomfort, malaise, fatigue, nausea, hair loss, and lifestyle restrictions(4,5). Close monitoring of DMARD intake is recommended and/or management of patients on monotherapy. Patient education is of prime importance as sustainability, clinical and radiological efficacy of biologic treatment will be compromised.
Choquette et al., Large discrepancy between expected and observed ratios of biologic treated Rheumatoid Arthritis patients also compliant on DMARDs, ACR congress abstract 2010
Soliman MM, et al., Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis Ann Rheum Dis 2011;70:583–589.
Rx Dynamics IMS-Brogan 2009-2011
Usage and Attitudes Survey, December 2010, 2011 IFOP North America
Patient Interviews and Surveys on Biologic/Methotrexate Combination therapy. Pharmafield Research, 2011
Disclosure of Interest D. Choquette Consultant for: Roche, Speakers Bureau: Roche, O. Thomas Employee of: Roche, M. Arundine Employee of: Roche