Background Use of biologics have shown to reduce some disease burden among patients with Rheumatoid Arthritis (RA). Relationship between disease severity at initial diagnosis and duration of use of first biologic has not been adequately evaluated in multi-country settings in European Union (EU).
Objectives To assess the impact of disease severity on duration of use of first biologic among patients with RA in UK, Germany, France, Italy and Spain.
Methods A multi-country multi-center medical chart-review study of RA patients was conducted between 3Q2011-1Q2012 among physicians (rheumatologists: 97%) in hospitals and private practices in EU to collect de-identified data on patients who were recently treated with a biologic as part of usual care. Physicians from the five EU countries (5EU) were screened for duration of practice (3-30 yrs) and patient volume (incl. ≥2RA biologic-patients/week) and recruited from a large panel to be geographically representative in each country. Medical charts for ∼10 successive patients visiting each center/practice during study-screening-period were abstracted to collect patient diagnosis, treatment patterns/dynamics and disease severity/status (per physician-judgment). Kaplan-Meier (KM) analysis was conducted to determine time-to-discontinuation of 1st-biologic by 50% of patients.
Results 4367 eligible RA patients were included in the analysis; mean age: 51.7 yrs; female: 71% (range: 63% (Germany) – 75% (France)). Geographic distribution of patients were – UK/France/Spain: 20% each, Germany: 18%, Italy: 21%. Percentage patients currently on 1st line biologic: 74% (range: 69% (France) – 77% (Italy)), on 2nd line biologic: 19% (19% in all countries except Spain (21%)), on ≥3rd line biologic: 7% (range: 4% (Italy) – 12% (France)). Time between diagnosis & 1st biologic: 52mo (range: 31mo (Spain) – 57mo (UK)). Medications used prior to 1st biologic were mostly Non-biological-DMARDs and corticosteroids. Disease-severity at diagnosis (mild:moderate:severe): overall – 11%:64%:22%, UK – 15%:57%:25%, Germany – 17%:68%:13%, France – 7%:63%:26%, Italy – 8%:65%:25%, Spain – 9%:70%:18%. Current disease-severity (mild:moderate:severe): overall – 50%:41%:8%, UK – 55%:30%:14%, Germany – 51%:41%:8%, France – 41%:48%:10%, Italy – 48%:47%:5%, Spain – 57%:38%:5%. Per KM analysis, time-to-discontinuation of 1st-biologic by 50% of patients was (months): 53 (UK-53/Germany-47/France-59/Italy-57/Spain-46); KM analysis stratified by disease-severity at initial RA-diagnosis revealed differences between disease-severity groups (5EU-aggregate): mild-61mo, moderate-56mo, severe-43mo; KM-analysis stratified by disease-severity at 1st-biologic initiation also revealed distinct differences (5EU-aggregate): moderate-61mo, severe-45mo (mild-group had inadequate events (of discontinuation) for evaluation).
Conclusions Among this large cohort of RA patients who received a biologic, disease severity differed within 5EU. Time-to-discontinuation of 1st biologic by 50% of patients also varied across 5EU, decreasing with increasing patient severity. Benefits associated with early detection and treatment of RA with biologics warrant closer scrutiny to alleviate patient burden.
Disclosure of Interest None declared