Background Tumour necrosis factor inhibitors (TNFi) have transformed the management of rheumatoid arthritis (RA). However, 28–41% of patients (pts) with RA receiving TNFi in clinical trials do not achieve an ACR20 response;1 inferior outcomes are usually observed when used without conventional synthetic DMARDs (csDMARDs).2
Objectives To evaluate 12-month (mo) treatment patterns, healthcare resource use (HCRU) and costs for pts with RA after initiation of index TNFi and switch from index TNFi to second-line biologic agent.
Methods This was a retrospective cohort analysis of pts aged ≥18 years with ≥2 outpatient or 1 inpatient visits for RA (ICD-9 code: 714.xx) who initiated TNFi in a US claims database (Truven Marketscan® Commercial Claims and Encounters and Medicare Supplemental Databases; 2010–2013). Pts with another inflammatory disease diagnosis of interest or who had pre-index biologic agent or >1 biologic agent within 14 days (d) were excluded. Treatment patterns were characterised by start of non-index biologic agent (switchers), gap >180 d between index prescription/administration and no other biologic agent (discontinuers) or no gap >180 d and no other biologic agent (continuers). Treatment patterns and all-cause/RA-related HCRU and costs were assessed over 12 mos post-index and in a subset of switchers within 180 d of last index TNFi prescription/administration who had another 12 mos continuous enrolment post-switch.
Results 9567 pts initiated TNFi, 44.6% without csDMARD. During follow-up (FU), 67.2% of pts were continuers, 17.3% discontinuers and 15.4% switchers (Figure). Switchers had greatest unadjusted 12-mo mean all-cause total costs ($34585) vs continuers ($33051) and discontinuers ($24915); 85.7%, 82.8% and 31.4%, respectively, of total costs were RA-related. Most of the 12-mo mean RA-related total cost ($24319) for all pts was due to prescriptions (74.4%) and outpatient visits (23.6%). Of 764 switchers with 12 mos continuous enrolment post-switch, 68.2% switched to alternative TNFi and 31.8% to non-TNFi biologic agent. Overall, 36.7% of pts who switched from index TNFi to second-line TNFi switched again during 12 mos of FU vs 27.6% of pts who switched from index TNFi to non-TNFi biologic agent (p=0.0134; Figure). Pts who switched to non-TNFi biologic agent had greater unadjusted 12-mo mean all-cause total costs ($76580) vs those who switched to an alternative TNFi ($50689). RA-related costs accounted for 58.4% and 54.3% of total costs for pts who switched to non-TNFi biologic agent and alternative TNFi, respectively. Biologic administration visits accounted for 78.8% ($14205) of the greater total RA-related costs of pts who switched to non-TNFi biologic agent vs alternative TNFi.
Conclusions In a US claims database, a large proportion of pts initiated TNFi without csDMARD. Real-world TNFi discontinuation/switch rates were similar to previous non-response rates.1 Pts who switched from TNFi to non-TNFi biologic agents were less likely to switch again but had greater costs overall, mostly due to biologic administration visits.
Agarwal SK et al. J Rheumatol 2008; 35: 1737-1744.
Emery P et al. Ann Rheum Dis 2013; 72: 1897-1904.
Acknowledgements This study was sponsored by Pfizer Inc. Editorial support was provided by Karen Irving at Complete Medical Communications and funded by Pfizer Inc.
Disclosure of Interest J. Harnett Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., D. Wiederkehr Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., R. Gerber Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., D. Gruben Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., A. Koenig Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., J. Bourret Shareholder of: Pfizer Inc., Employee of: Pfizer Inc.
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