Background The treatment of Rheumatoid arthritis (RA) in Australia is consistent with the current international guidelines of starting a biologic (b) DMARD in combination with methotrexate (MTX) where possible and/or other synthetic DMARDs with or without glucocorticoids (GCs). There is limited data available on the effects of various bDMARDs on oral GCs consumption in a real world data setting and in the same patient population.
Objectives The objective of the study was to investigate the usage of concomitant GCs with bDMARDs for the treatment of RA patients over time.
Methods Concessional (government subsidised) RA patients ≥18 years of age for whom bDMARDs were first dispensed for their RA (between 01August 2010 and 31July 2013), and who were in the Australian Medicare 10% sample database provided by the Department of Health and Aging through an Australian healthcare consulting company (PROSPECTION) were followed for a period of 2 years (until 31 July 2015). bDMARDs included: abatacept (IV and SC), adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, and tocilizumab. Data were analysed using descriptive statistics for continuous variables and frequency counts for categorical variables. Individual anti-TNFs were equivalent in all analyses and therefore were combined for simplicity.
Results Data from 269 patients were analysed. Of the patients who received oral GCs at some point during the study period (86%; n=230), 49% were ≥65 years old and 51% were 18–64 years old. The majority (81%) were females. For all patients, median dose of oral GCs was 4.1 (min 0, max 21) mg/day at one year prior to initiation of a bDMARD, 2.9 (min 0, max 22.2) mg/day and 2.0 (min 0, max 17.3) mg/day at 1 and 2 years, respectively, post-bDMARDs initiation. Daily GCs doses across the analysis time points and by drug group are presented in Table 1. Daily dose changes at 1–2 years post initiation of bDMARDs from 1 year before initiation of bDMARDs were statistically significant for all bDMARDs (p<0.0001), all anti-TNFs (p<0.0001) and tocilizumab (p=0.0002). Percentage of patients who stopped GCs at any time post initiation of a bDMARD was 43% for all RA bDMARDs, 44% for all anti-TNFs, 27% for abatacept and 39% for tocilizumab. 31 percent of patients who remained on biologics for the observation period in the “all RA bDMARDs” group had an increase in GCs dose and 60% had a decrease after 1-year and 65% after 2 years; percentage increase and decrease in GCs doses for all groups are listed in Table 2.
Conclusions In the Australian setting, the majority of RA patients who were taking oral GCs had reductions in their daily GCs doses after initiation of bDMARDs; which continued for up to 2 years post treatment initiation.
Acknowledgement The study was sponsored by Roche Products Pty. Limited. Medical writing was provided by Dr Joseline Ojaimi from Roche.
Disclosure of Interest G. Jones: None declared, S. Hall: None declared, G. Littlejohn: None declared, E. Chung Consultant for: Roche Products, Pty. Ltd, R. Barrett Employee of: Roche Products, Pty. Ltd, P. Button Employee of: Roche Products, Pty. Ltd