Background Current management of rheumatoid arthritis (RA) in the United States is often directed by payer medical policy, typically requiring a tumour necrosis factor-α inhibitor (TNFi) as a first-line (1L) biologic disease-modifying antirheumatic drug (bDMARD). Recent studies1 suggest clinical subsets of patients with RA may benefit from early intervention with a non-TNFi bDMARD.
Objectives To characterise 6 month healthcare resource utilisation (HRU) for patients with RA in the United States when treated with different 1L bDMARDs (1L TNFi or 1L abatacept) and assess the impact of initial bDMARD selection on 6 month HRU.
Methods Early, rapidly progressive RA (eRPRA) is a recognised clinical entity comprising a constellation of clinical and biomarker features: anti-cyclic citrullinated peptide-2 positivity (ACCP+), DAS28 (CRP) ≥3.2, symptomatic synovitis in ≥2 joints for ≥8 weeks and onset of symptoms≤2 years. Physicians with adult RA patients meeting these criteria for eRPRA used patient medical records to provide patient data via an electronic case report form. Patients received either abatacept or TNFi in 1L. Patient characteristics and HRU in the first 6 months of bDMARD treatment were summarised and compared across treatment groups. Odds ratios (OR) of HRU were estimated using multivariable logistic regression to adjust for baseline indicators of disease severity and patient mix (age, sex, race, ethnicity, region, payer type, time from RA diagnosis to bDMARD start, baseline concomitant medication use, baseline swollen joint count [SJC], tender joint count [TJC], Clinical Disease Activity Index [CDAI], extra-articular manifestations).
Results There were 60 abatacept and 192 TNFi patients in 1L. Mean ages at bDMARD start were 49.1 and 49.9 years, and mean times from RA diagnosis to bDMARD initiation were 1.5 and 6.4 months for abatacept and TNFi users, respectively (all p>0.05). At bDMARD start, patients with eRPRA treated with abatacept or TNFi, respectively, had mean SJC of 6.8 and 7.3, TJC of 10.4 and 10.2, ESR of 39.8 and 44.0 mm/h, CRP of 8.1 and 8.2 mg/L and numbers of bony erosions of 1.2 and 1.7 (all p>0.05). 45% and 47% (p>0.05) of abatacept and TNFi users, respectively, had concomitant oral corticosteroids at bDMARD start. A lower proportion of patients treated with abatacept had hospitalizations (72 vs 88%), emergency department (ED) visits (75 vs 90%) and MRI (65 vs 82%) (all p<0.05), while use of ultrasound (82 vs 88%) and radiography (88 vs 93%) during the first 6 months of bDMARD treatment was similar. After adjusting for patient characteristics, those treated with 1L abatacept had significantly lower odds of hospitalisation (OR 0.42; 95% CI 0.18, 0.95), ED visits (OR 0.39; 95% CI 0.16, 0.93) and MRI (OR 0.45; 95% CI 0.21, 0.97) compared with 1L TNFi (all p<0.05). Adjusted odds of achieving CDAI low disease activity within 100 days of bDMARD favoured 1L abatacept vs 1L TNFi (OR 3.26; 95% CI 1.32, 8.07; p<0.05).
Conclusions After adjusting for baseline disease severity, patients treated with 1L abatacept were less likely to have hospitalizations, ED visits and MRIs during the first 6 months of bDMARD treatment compared with those who received a 1L TNFi.
Reference  Turesson C, et al. Arthritis Rheum2014;66(S10);S217abstract 501.
Disclosure of Interest A. Klink Consultant for: Bristol-Myers Squibb, Janssen, Celgene, EMD Serono, Ipsen, Kite, Merck, Novartis, Vertex, Amgen, Astellas, Heron, AbbVie, Array, Seattle Genetics, Employee of: Cardinal Health, K. Tuell Employee of: Bristol-Myers Squibb, R. Szymialis Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, T. Curtice Employee of: Bristol-Myers Squibb, K. Gupta: None declared, D. Nero Consultant for: Bristol-Myers Squibb, Employee of: Cardinal Health, B. Feinberg: None declared
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