Background RA is an inflammatory autoimmune disease associated with increased prevalence of depression and cardiovascular comorbidities1,2. A T2T approach to therapy has been shown to significantly improve RA patient outcomes over usual care.
Objectives To compare incidence rates of depression and major cardiovascular events in RA patients with a T2T approach to therapy to a matched group of RA patients with usual care.
Methods This retrospective cohort study used MarketScan administrative claims databases to select adults with at least 1 inpatient or 2 outpatient diagnoses of RA (ICD-9-CM 714.0x) at least 30 days apart and within a year during 1/1/2005 to 1/31/2014. The index event was the first biologic or non-biologic disease-modifying antirheumatic drug at least 6 months following diagnosis. Patients had 6 months of pre-index continuous enrollment and follow-up was variable in length with a 1 year minimum imposed (baseline year). Patients were categorized as having T2T approach if they had at 3 or more visits to a rheumatologist where the initial visit was within the first 90 days of follow-up and were determined to have low disease activity through implementation of a validated claims-based algorithm3 during the baseline year. Patients that did not meet both criteria were identified as having usual care. Incidence rates of depression (diagnosis or treatment) and major cardiovascular events (stroke or myocardial infarction) were calculated for the T2T cohort and the matched usual care cohort. Kaplan Meier (KM) method was used to examine the probability of time to event between groups.
Results Of the 80,509 RA patients, 10.4% (N=8,333) were identified as having T2T based management strategy and matched 1:1 to 8,333 of the 72,174 (89.6%) patients with usual care. After matching both cohorts had similar demographic characteristics (e.g., mean age 57.5 years, 73% female).Compared to the usual care cohort, a significantly (p<0.001) lower proportion of patients in the T2T cohort were newly diagnosed with a major cardiovascular event (2.5% vs. 3.2%) or newly treated for or diagnosed with depression (12.9% vs. 16.3%). Patients in the T2T cohort had a lower depression rate (1.56 vs. 2.14) per 10,000 person-years (PY) and major cardiovascular event rate (0.22 vs. 0.28) compared to patients with usual care. KM analysis also suggested that patients in the T2T cohort (versus usual care) had a significantly higher probability of not experiencing depression or a major cardiovascular event during follow-up (log rank tests all p<0.001) (Figure).
Conclusions A T2T approach to RA management was associated with lower incidence of major cardiovascular events and depression and should be considered when prescribing care. Future studies in different populations are needed to confirm these findings.
Matcham F., Rayner L, Steer S., et al. The prevalence of depression in rheumatoid arthritis:a systematic review and meta-analysis. Rheumatology 2013; 52:2136–43
Kremers H, Nicola P, Crowson C., et al. Cardiovascular death in rheumatoid arthritis. Arthritis and Rheumatism 2005; 52:722–732
Curtis JR, Baddley JW, Yang S., et al. Derivation and preliminary validation of an administrative claims-based algorithm for the effectiveness of medications for rheumatoid arthritis. Arthritis Research & Therapy. 2011;13:R155
Disclosure of Interest N. Princic Employee of: Employee of Truven Health Analytics which was funded by AbbVie to conduct this research, D. Fugh Employee of: Employee of Truven Health Analytics which was funded by AbbVie to conduct this research, B. C. Chu Employee of: Employee of Truven Health Analytics which was funded by AbbVie to conduct this research, V. Garg Employee of: Employee and AbbVie and may hold stocks in AbbVie