Background Biologic use among patients with rheumatoid arthritis (RA) is increasingly common. Given different anti-tumor necrosis factor (TNF) options, a better understanding of factors that influence physicians’ and patients’ selection of RA therapies and comparative effectiveness between them is warranted.
Objectives To describe physicians’ and patients’ preferences in selecting specific biologics and comparing clinical response using patient reported outcomes (PROs) among RA patients started on different anti-TNF therapies.
Methods Eligible patients for this analysis were enrollees in Kaiser Permanente Northern California, a large, well-characterized integrated care organization. RA patients with at least 2 Kaiser visits who started a new anti-TNF therapy from 10/2010 – 8/2011 were initially eligible for participation in a longitudinal telephone survey at baseline (initiation of anti-TNF therapy) and 6 months later. There were 384 patients eligible available to be contacted. Ordinary least squares regression evaluated the change at 6 months across PROs comparing etanercept (ETA) vs. adalimumab (ADA) initiators and controlled for multiple potential confounders.
Results A total of 267 RA patients were recruited and completed the baseline survey; 244 completed the follow-up survey. Mean age was 54.4 (SD ± 12.1) and 73.4% were females. Of these, 42% were employed and 14% were disabled. A total of 56% of patients self-reported that they were involved in the selection of their specific biologic. The majority of patients (57%) preferred an injectable biologic, 22% preferred an infused biologic, and 21% had no preference. Preferences for injection biologics were mainly motivated by convenience (92%); those preferring infusion therapy were motivated by dislike or lack of self-efficacy for self-injection (15.7%). After 6 months of treatment with anti-TNF biologics, 44% of the patients reported a level of burning and stinging with injection of ≤ 4 in a scale of 0-10 with the last biologic dose, 30% experienced a level > 5 and 26% reported no burning and stinging. RAPID 3, MDHAQ and SF12_pcs were significantly better at 6 months favoring ETA compared to ADA (table).
Conclusions Convenience, fears of self-injection and self-efficacy for self-injection were important aspects to patients when selecting an individual therapy. There were small but statistically significant differences in efficacy based on PROs at 6 months between etanercept and adalimumab.
Acknowledgements Thi work was supported by (R01 HS01857). Dr. Curtis receives support from the NIH (AR 053551).
Disclosure of Interest J. Curtis Grant/research support from: Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizr, BMS, Crescendo, AbbVie, Consultant for: Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizr, BMS, Crescendo, AbbVie, I. Navarro-Millan: None Declared, L. Chen: None Declared, L. Harrold Grant/research support from: NIH K23AR053856, Consultant for: CORRONA, L. Liu: None Declared