Background Although efficacy of biologics approved for moderate to severe RA is similar in clinical trials, there may be differences in individual patients. As choices for biologic treatment increase, switching, discontinuation, and restarting is common.
Objectives To explore treatment patterns with etanercept, adalimumab, infliximab, abatacept, certolizumab, golimumab, and rituximab in adult patients with RA.
Methods The MarketScan Commercial Database was used to identify adults (18-63 years) with RA and ≥1 claim for a biologic of interest between Jan 1, 2008 and Dec 31, 2010 preceded by ≥6-months of enrolment. The first claim meeting these criteria defined the index date and biologic. Patients were grouped based on the first event post index. Patients were “persistent” if they did not have claims for another biologic and continued on their index biologic for 1-year; “switchers” had a claim for another biologic; “restarters” had a 45-day gap after the end of days of supply and a subsequent claim for the index drug. Patients were classified as discontinuing their index biologic if they did not persist for one year.
Results Of 38,026 patients, 95% indexed on four of the biologics, etanercept (41.6%), adalimumab (27.2%), infliximab (19.2%) and abatacept (6.6%). Of the others, 3.5% received rituximab, 1.2% received golimumab, and 0.6% received certolizumab. Switching rates ranged from 8% for rituximab to 21% for golimumab. Persistence ranged from 38% for rituximab to 67% for infliximab. Restart rates ranged from 7% in infliximab to 16% in etanercept and rituximab. Discontinuation ranged from 15% in infliximab to 38% in rituximab.
Conclusions Of the four most frequently prescribed biologics in RA, infliximab users were more likely to be persistent and correspondingly less likely to restart than patients on other agents. Patients starting on subcutaneously (SC) administered agents were most likely to switch to other SC agents, and patients starting in intravenous (IV) agents were more likely to switch to other IV agents. Discontinuation rates were similar across agents.
Disclosure of Interest M. Bonafede: None Declared, G. Joseph Shareholder of: Amgen Inc., Pfizer Inc., Employee of: Amgen, N. Princic: None Declared, N. Shah Shareholder of: Amgen Inc., Employee of: Amgen, D. Harrison Shareholder of: Amgen Inc., Employee of: Amgen