Background Biotherapies such as subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) have transformed the management of inflammatory joint diseases such as rheumatoid arthritis (RA). The assessment of SC- TNFis persistence and its determinants is needed.
Objectives The objective of this study was to describe treatment persistence in real-world settings, and identify the determinants of persistence among RA patients initiating treatment with an SC-TNFi.
Methods The French national health insurance scheme database lists all outpatient and inpatient healthcare consumption for individuals covered by the general health insurance scheme. Using French claims data, RA was diagnosed using Long Term Disease status and hospital admission, based on ICD-10 codes. Patients were then identified through prescription filled for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP) and golimumab (GLM) between 2012/07/01 and 2013/12/31. A patient was considered as non-persistent in the event of a prolonged interruption of the therapy lasting 91 days or more. Persistence was estimated with Kaplan Meier analysis. Determinants of persistence in the 12 months before initiation were identified using Cox models.
Results A total of 7,204 patients with RA were identified. In the descriptive analyses of the 12 months persistence, differences were observed for RA patients, with raw/non-adjusted persistence rates of 51.8% for CZP, 57.4% for ETA, 53.7% for ADA and 56.6% for GLM. Results of the Cox model are presented below, including hazard ratio for biotherapy, adjusted on sex, age, socio-economic status, and criteria on disease severity. The variables biotherapy, sex and socio-economic status did not meet the proportionality hypothesis of risks, and were corrected by the addition of a variable integrating the interaction with time.
Conclusions Non-persistent patients were more likely female, with multiple comorbid conditions, and multiple line of biotherapy. Hospital admission for IRMD, visits to rheumatologist and treatment with GLM (compared to CZP, ETA and ADA) decreased the risk of non-persistence. Further analyses are needed to better understand behaviours of patients and to assess the impact of non-persistence on clinical and economics outcomes.
Disclosure of Interest B. Fautrel Grant/research support from: AbbVie, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgène, Hospira, Janssen, Lilly, MSD, NORDIC Pharma, Pfizer, Roche, SOBI, UCB, M. Belhassen Employee of: PELyon, C. Hudry Consultant for: ABBVIE, MSD, BMS, PFIZER, ROCHE, CELGENE, NOVARTIS, BIOGEN, UCB, SANDOZ, AMGEN., Employee of: COCHIN Hospital, M.-C. Woronoff: None declared, N. Gouyette Employee of: MSD France, A. Clément Employee of: MSD France, E. Van Ganse Consultant for: PELyon; ALK ABELLO; AstraZeneca; Bayer; BMS; BIF; GSK; IMS; LASER; MSD, F. Tubach: None declared