Background For some patients with Immune Mediated Rheumatic Disease (IMRD) discontinuing 1st line treatment with a subcutaneous Tumor Necrosis Factor-alpha inhibitor (SC-TNFi), 2nd line treatment with another SC-TNFi may be appropriate.

Objectives The primary objective of this study was to describe treatment persistence with 2nd line SC-TNFi stratified by agent in patients with IMRD in Sweden. The secondary objective was to explore the impact of non-persistence with a second SC-TNFi on health care costs.

Methods We conducted a retrospective study on treatment persistence and health care costs using data from health registers. Adults (≥18 years old) previously treated with one SC-TNFi and subsequently prescribed a second SC-TNFi were identified through prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP) and golimumab (GLM) between 5/6/2010 and 12/31/2012. Prescriber specialty and department were used to exclude patients treated for diseases other than IMRD. Persistence up to 3 years was estimated using non-parametric survival analysis. Given differences in baseline characteristics, analyses were conducted on propensity score matched (PSM) cohorts. Matching was based on age, gender, index year, diagnosis, Charlson Comorbidity Index and non-biologic DMARD use. Non-treatment health care costs were captured 12 months pre and post initiation of 2nd line SC-TNFi treatment and stratified by persistence status at 6 months.

Results In total, 845 patients were identified (ADA: 316, ETA: 202, CZP: 140, GLM: 187). PSM cohorts were generated as GLM vs ADA, GLM vs ETA and GLM vs CZP, with 187, 164, and 113 matched pairs, respectively. GLM exhibited statistically significant higher persistence than ADA over 3 years (Figure; p=0.040) and numerically, but not statistically significant, higher persistence than ETA and CZP at 12 and 24 months. Persistent and non-persistent patients had similar mean total cost 12 months pretreatment initiation (USD 5,185 vs USD 5,064, p=0.750). During the 12 months post treatment initiation, persistent patients had lower mean total costs (USD 4,377 vs USD 6,605), corresponding to a difference in difference of USD 2,228 (p<0.001).

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Conclusions In patients previously treated with a SC-TNFi, GLM exhibited significantly better persistence than ADA and numerically higher persistence than ETA and CZP at 12 and 24 months, findings that are similar to results observed in 1st line SC-TNFi patients¹. Given the lower healthcare costs for persistent patients, the choice of 2nd line SC-TNFi among eligible patients may merit careful consideration given its impact on patients and payers.

References

1. Dalén, J, et al. Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence. Rheumatol International (2016): 1–9.

References

Disclosure of Interest J. Dalén Consultant for: Merck & Co., Inc., Employee of: Mapi group, A. Svedbom Consultant for: Merck & Co., Inc., Employee of: Mapi group, C. Black Shareholder of: Merck & Co., Inc., Employee of: Merck & Co., Inc., S. Kachroo Shareholder of: Merck & Co., Inc., Employee of: Merck & Co., Inc.