Background Rheumatoid arthritis is a chronic illness associated with pain and disability making it difficult to function.
Objectives This study proposes to characterize baseline quality of life in biologic naïve rheumatoid arthritis (RA) patients just prior initiation of their first biologic.
Methods Biologics naïve RA patients who initiated their first biologic (abatacept, TNFi and non-TNF biologic) or small molecule between 12/2005 and 08/2014 within the Corrona, LLC registry were identified. Initiation of first biologic or small molecule (first line use) was defined as first indication of biologic use for a patient that was previously naïve to any biologic or small molecule prior to initiation of study drug. Baseline characteristics at the time of biologic initiation were captured including demographics, clinical disease activity index (CDAI), patient global assessment, patient pain, functional status (using the modified Health Assessment Questionnaire [mHAQ]), as well as ambulation, self-care, performance of usual activities, and feeling anxious/depressed based on the EQ5-D. The impact of RA was assessed overall and by medication type. Specifically descriptive statistics were performed including t-tests and Chi-square tests comparing abatacept initiators to TNFi initiators and initiators of other non-TNF biologics and small molecules (non-TNFi/sm).
Results Among 4,232 first time biologic users, 364 (9%) initiated abatacept, 3689 (87%) TNFi, and 179 (4%) other non-TNFi/sm. Abatacept initiators as compared to TNFi initiators were more likely to be older (62.8 years vs. 56 years; P<0.001), and female (81% vs. 75%; P=0.039). However, disease activity based on the CDAI was similar in the three treatment groups. Overall, the patients reported substantial impairment from RA in terms of patient global assessment (mean 40.6±27.4), patient pain (mean 42.7±28.4), patient fatigue (mean 44.8±30.1), duration of morning stiffness (mean 1.7 hours ±3.6) and functional impairment (mean mHAQ score 0.46±0.4). With regard to impact on global functioning, the majority of patients reported problems walking (58%) and performing usual activities (64%). Challenges with performing self-care activities were present in 32%. In addition 38% were experiencing anxiety and/or depressive symptoms. There were no differences based on the type of biologic/small molecule initiated (Table 1).
Conclusions Most RA patients at the time of their first biologic initiation were substantially impacted by their arthritis in terms of pain, fatigue, functional status and ability to perform usual activities and walking. This was despite the majority of patients receiving nonbiologic disease modifying anti-rheumatic drugs. There were no substantial differences based on the type of biologic/small molecule medication initiated.
Acknowledgements This study is sponsored by Corrona, LLC. The Corrona RA registry has been supported through contracted subscriptions in the last two years by AbbVie, Amgen, Astra Zeneca, BMS, Genentech, Horizon Pharma USA, Janssen, Eli Lilly, Novartis, Pfizer, and UCB.
Disclosure of Interest L. Harrold Grant/research support from: Corrona, LLC., K. Gandhi Employee of: Bristol-Myers Squibb, C. Etzel Employee of: Corrona, LLC., A. Nadkarni Employee of: Bristol-Myers Squibb, K. Saunders Employee of: Corrona, LLC., S. Kelly Employee of: Bristol-Myers Squibb, J. Greenberg Shareholder of: Corrona, LLC., Consultant for: AstraZeneca, Celgene, Novartis and Pfizer, Employee of: Corrona, LLC.