Background Previous meta-analyses suggest improved efficacy of ADA+MTX compared to TCZ+MTX, however, no comparison was made to TCZ monotherapy.1
Objectives To compare the real-world effectiveness of ADA+MTX vs TCZ in treating biologic-naïve RA patients.
Methods A retrospective (2005–2013), longitudinal cohort study was performed using a large US commercial administrative claims database. Biologic-naïve patients aged ≥18 years with a 1st diagnosis of RA and no diagnosis of spondyloarthritis, psoriasis, psoriatic arthritis, ulcerative colitis, or Crohn's disease within the study period were included. Patients who initiated ADA+MTX therapy were matched 1:1 with patients who initiated TCZ monotherapy, based on RA duration (±30 days) and date of biologic initiation (±360 days). Effective disease control over 1 year was defined using a validated algorithm that included the following elements: high adherence to the target biologic therapy (≥80% ADA adherence by medication possession ratio or receipt of 11–12 TCZ infusions), biologic dose escalation, switching to/adding a biologic or nonbiologic disease-modifying antirheumatic drug (nbDMARD), escalation of oral corticosteroid dose, or receipt of >1 glucocorticoid joint injection2. Effectiveness was compared after adjusting for the following covariates using multivariate logistic regression and Cox proportional hazard analyses: age, sex, Charlson Comorbidity Index, insurance type, geographic region, RA duration, number of prior DMARDs used, and number of rheumatologist visits between baseline and 1 year.
Results Mean age among 648 patients included (324 ADA+MTX; 324 TCZ) was 49.4 years; 18.1% were male. Baseline sociodemographic and clinical characteristics were similar between patient cohorts. At year 1, a significantly greater proportion of patients on ADA+MTX achieved effective disease control vs those on TCZ (29.6% vs 15.4%; P<0.001). Patients on ADA+MTX were less likely than those on TCZ to switch or add nbDMARDS (3.4% vs 10.8%; P<0.001), to escalate their biologic dose (17.0% vs 48.8%; P<0.001), or to have a 2nd corticosteroid injection (4.9% vs 11.4%; P=0.003). When controlling for baseline sociodemographic and clinical characteristics, patients on ADA+MTX were more likely than those on TCZ to be effectively treated (odds ratio=2.43, 95% CI=1.36 to 4.32). Compared to TCZ monotherapy, ADA+MTX treatment was associated with lower probability of switching or adding nbDMARDs, biologic dose escalation, or >1 corticosteroid joint injection (Table).
Conclusions This study demonstrated real-world superiority of ADA+MTX therapy over TCZ monotherapy among RA patients. Future research to examine these findings in a randomized clinical trial may provide further evidence in this area.
Liu Y et al. Adv Ther. 2012;29(7):620–34.
Curtis JR et al. Arthritis Res Ther. 2011;13:R155.
Disclosure of Interest V. Garg Shareholder of: AbbVie, Employee of: AbbVie, J. Griffith Shareholder of: AbbVie, Employee of: AbbVie, O. Hayes Shareholder of: AbbVie, Employee of: AbbVie, Y. Bao Shareholder of: AbbVie, Employee of: AbbVie
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.