Background Patients with rheumatoid arthritis (RA) often have significant comorbidity which, along with underlying RA severity, may impact both choice and response to treatment. We have previously shown that patients initiating first-line intravenous (IV) abatacept had higher baseline RA-related and overall health care costs and higher comorbidity scores than those patients initiating first line infliximab. However, it is not known how the characteristics of patients who switch to abatacept from a previous biologic compare with those prescribed other agents as a second-line biologic.
Objectives To compare degree of comorbidity, disease (RA) severity, and baseline health care costs in RA patients prior to initiating second-line biologic treatment with abatacept, adalimumab, etanercept or infliximab.
Methods Utilizing a large managed care plan claims database in the United States, an analysis was conducted in adult RA patients during the six months prior to initiating second-line biologic treatment with abatacept, adalimumab, etanercept or infliximab. The identification period was January 01, 2006 through June 15, 2010. Severity of overall comorbidity was described using Charlson Comorbidity Index (CCI) and all-cause health care costs, while RA-related health care costs (including medication costs) were used as a proxy measure of RA severity.
Results A total of 10,330 RA patients were identified who initiated treatment with one of the study agents as second-line biologic therapy. Baseline CCI and total all-cause health care costs were significantly higher for abatacept-treated patients (p<0.01; Table). Baseline RA-related health care costs for abatacept-treated patients were significantly higher than those of patients treated with adalimumab or etanercept.
Conclusions As shown previously in first-line biologic patients, in a commercially insured population, patients initiating IV abatacept as second-line treatment demonstrated more baseline comorbidity than those who received adalimumab, etanercept, or infliximab, and greater severity of RA than those who received adalimumab or etanercept. Further research is required to better understand how pre-existing conditions and severity of RA impact selection of biologic therapy and subsequent response in this patient population.
Darkow, T et al. Comorbidity and Cost Burden of Patients Prior to Initiating Abatacept or Infliximab as First-Line Biologic Therapy for the Treatment of Rheumatoid Arthritis. Poster presentation, ACR Congress, November 5–9, 2011 Chicago, USA.
Disclosure of Interest D. Trivedi Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, L. Rosenblatt Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, T. Darkow Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, B. Chastek Consultant for: Bristol-Myers Squibb, Employee of: OptumInsight, T. Hebden Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb