Background Chronic inflammatory diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis (PsO) increase the risk of cardiovascular (CV) disease. However, a gap in knowledge exists regarding detailed information on changes in immunosuppressive (DMARD) treatments after a CV event.
Objectives We describe treatment patterns among patients with RA, PsA, or PsO who were being treated with DMARDs prior to a CV event.
Methods Patients with RA, PsA, or PsO, who experienced a CV event (acute myocardial infarction, stroke, or cardiac revascularization) between 1/1/2006 and 6/30/2015 were identified in an administrative claims database. Index date was defined as the hospital discharge date for the first CV event during the study period. Patients were required to: be continuously enrolled for 12 months prior to index date; have ≥1 TNFi claim, or a conventional synthetic (cs)DMARD claim, or another biologic DMARD claim within 6 months prior to the index date; and have ≥30 days of follow-up after index date. Treatment patterns were assessed after index date and patients were classified as remaining on (“persistent”), switching, or discontinuing pre-index DMARD medication.
Results We identified 9,529 patients with RA, PsA, or PsO; prior to the index date, 3,274 (34.4%) patients were on TNFi, 5,177 (54.3%) were on only csDMARDs as monotherapy or combination, and 1,078 (11.3%) were on non-TNFi biologics. Patients on csDMARDs at index date were older (69.4 yrs) than those on TNFi (64.1 yrs) or other biologic DMARDs (66.0 yrs). Approximately 73% of patients were persistent on their pre-CV event treatment, with higher persistence among csDMARD alone (76.0%) and TNFi + csDMARD combo (76.7%) groups and lower in the non-TNFi biologic + csDMARD combo group (60.8%, Table 1). Across all treatment groups, 95% of persistent patients resumed treatment within 90 days after the index CV event. Combination therapy users switched their pre-CV event treatment more than monotherapy users, with non-TNFi biologic users more likely to discontinue all therapy after index CV event. Patients that discontinued all therapy after an index CV event tended to be slightly older females (68.7 yrs vs 67.1 yrs), with a history of PsO (24.4% vs 16.1%), and stroke as index event (49.3% vs 41.3%) compared to those that continued therapy.
Conclusions In a large US database reflective of typical clinical practice, nearly one-quarter of patients with RA, PsA, or PsO discontinued or switched the pre-event DMARD treatment after a CV event. Further research is needed on whether these DMARD treatment patterns after initial CV event affect risk of repeat CV event.
Disclosure of Interest J. Sparks Grant/research support from: Amgen, Inc., T. Lesperance Consultant for: Amgen, Inc., N. Accortt Shareholder of: Amgen, Inc., Employee of: Amgen, Inc., D. Solomon Grant/research support from: Amgen, Inc.