ObjectivePoor adherence to therapy increases the patient and societal burden and complexity of chronic diseases such as rheumatoid arthritis (RA). In the past 15 years, biologic disease-modifying anti-rheumatic drugs (DMARDs) have revolutionized the treatment of RA. However, little data are available on the impact of adherence to biologics on health care resources. The objective of the study was to determine the long-term health care resource utilization patterns of RA patients who were adherent to biologic DMARD therapy compared to RA patients who were non-adherent to biologic DMARD therapy in an Ontario population and to determine factors influencing adherence.MethodsPatients were identified from the Ontario RA Database that contains all RA patients in Ontario, Canada, identified since 1991. The study population included RA patients, aged 65+ years, with a prescription for a biologic DMARD between 2003 and 2013. Exclusion criteria included diagnosis of inflammatory bowel disease, psoriatic arthritis or psoriasis in the 5 years prior to the index date and discontinuation of biologic DMARD, defined as no subsequent prescription during the 12 months after the index date. Adherence was defined as a medication possession ratio of ≥0.8 measured as the proportion of days for which a patient had biologic treatment(s) over a defined follow-up period. Adherent patients were matched to non-adherent patients by propensity score matching.ResultsA total of 4,666 RA patients were identified, of whom 2,749 were deemed adherent and 1,917 non-adherent. The age (standard deviation) was 69.9 (5.46) years and 75% were female. Relative rates for resource use (physician visits, emergency visits, hospitalization, home care and rehabilitation) for the matched cohort were significantly lower (P⩽0.0001) in adherent patients. Non-adherent patients’ use of oral prednisone (67%) was significantly higher (P⩽0.001) than that of the adherent cohort (56%).ConclusionRA patients adherent to biologic therapy have lower health care resource use and lower steroid use compared to non-adherent patients.

BackgroundThe aim of the study was to compare drug survival rate of subcutaneous tumor necrosis factor alpha inhibitors in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis patients in Hungary.MethodsThis was a retrospective analysis using data collected from 5,647 patients over a period of 10 years who were treated with any of the following drugs: adalimumab (ADA), etanercept, certolizumab pegol (CZP), and golimumab (GLM). National Health Insurance Fund’s hospital, drug reimbursement, and special reimbursement registry data have been used in this study. Drug survival rate was calculated according to Kaplan–Meier survival analysis. Propensity score matching was used to reduce the potential bias caused by the inhomogeneity resulting from demographic characteristics, patient pathways, or drug administration protocols. Both raw and propensity matched data were subject of pairwise comparison between the four subcutaneous therapies.ResultsThe overall rate of persistence for the 4 biological therapies was between 53% and 61% after 1 year and between 14% and 19% after 4 years (follow-up time). Pairwise comparisons between therapies showed significant differences with GLM-treated patients showing longer median survival times than patients on other therapies. After propensity matching, these differences remained statistically significant between GLM and ADA or CZP over 4 years.ConclusionHungarian show longer persistence to GLM compared to ADA and CZP.

Methods: Markov modelling was used to estimate ten-year incremental costs and QALYs for two treatment strategies following partial response [PASI ≥ 50 and < 75] to ustekinumab dosed every twelve weeks. Patients either continued on ustekinumab at an 'optimized' dosing of every eight weeks (45mg and 90mg) or 'switched' to anti-TNF treatment. Lack of published RCT data for second-line response to anti-TNFs resulted in the conservative selection of infliximab (a highly efficacious anti-TNF) to represent the anti-TNF class. Patients transitioned between 'Response' (higher utility) and 'Best Supportive Care' health states. Response (defined as PASI≥ 75) rates in a 26 week trial period were: ustekinumab 45mg = 44%, 90mg = 55% (n= 91 and n = 75 respectively, PHOENIX trials); anti-TNF class = 72%, (n= 94, EXPRESS II bio-experienced infliximab patients). Real world evidence informed treatment specific drug survival rates. Costs included biologics, supportive treatments, outpatient and inpatient care, and lost productivity. Input variables were subject to deterministic and probabilistic testing. Costs and QALYs were discounted at 5% p.a. and the ICER was used to compare strategies. Results: In a probabilistic incremental analysis anti-TNF treatment was less costly per patient

A 1 -A 3 1 8 A235 identified in the IMS PharMetrics Plus database. All patients were evaluated for year 1 treatment effectiveness using a validated algorithm and for persistence (gap < 90 days). Year 2 adherence (PDC > 80%) on index drug was assessed in both effectively treated and persistent patients. Patients not effectively treated in year 1 due to nonadherence were evaluated separately for year 2 adherence. Results: Of the 10,374 eligible patients, 76.1% were female, median age was 51 years, and 77.9% were on a previous DMARD. In year 1, 29.7% were effectively treated and 47.5% were persistent. Among all patients, 46.0% and 33.6% were adherent over the entire one and two year periods, respectively. Effectively treated patients had higher adherence in year 2 compared to non-effectively treated patients, 59.0% vs 31.5% (p< 0.0001). Patients persistent during year 1 had significantly higher year 2 adherence compared to their non-persistent counterparts, 60.6% vs. 10.6% (p< 0.0001). In patients not effectively treated due to non-adherence, only 12.3% were adherent to their index drug in year 2. ConClusions: Patients who were initiated on and effectively treated with biologics for RA in year 1 had higher adherence in year 2 compared to non-effectively treated patients. Establishing effective treatment in year 1 should result in improved adherence and maintained low disease activity in year 2.

BackgroundPoor adherence to therapy increases the burden and complexity of chronic diseases such as rheumatoid arthritis (RA). In the past 15 years, biologics have revolutionized the treatment of RA. However, little data is available on impact of adherence to biologics on health-care resources.MethodsAs part of a pilot project at the Institute for Clinical Evaluative Sciences (ICES), analyses were performed by ICES scientists on ICES administrative data to study the research question provided by Janssen Inc. Note, the approach and methodological details were determined by Janssen researchers. Patients were identified from the Ontario RA Database which contains all Ontario RA patients identified since 1991. Study population included RA patients, age 65+, with a prescription for a biologic drug between January 1, 2003 and December 31, 2013. Exclusion criteria are diagnosis of inflammatory bowel disease, psoriatic arthritis or psoriasis in the 5 years prior to the index event and discontinuation of biologic drug during the 12 months after the index event. Adherence was defined as a Medication Possession Ratio (MPR) of ≥0.8 measured as the proportion of days for which a patient had biologic treatment(s) over a defined follow-up period. Adherent were matched to non-adherent patients on a propensity score calculated using seventeen variables capturing patient demographics and heathcare resource use in the year prior to index event.ResultsA total of 4,667 RA patients were identified. Patients had a mean age (SD) of 69.9 (5.46) years and 75% were female. Of the total study cohort 1,877 matched pairs were identified (adherent to non-adherent patients). Relative rates for resource use (GP and cardiologist visits, ED visits, hospitalization, home care and rehabilitation) for the matched cohort were significantly lower (p<0.0001) in adherent patients. Additionaly the median (IQR) length of stay of hospitilizations was shorter for adherent patients - 10 days (4–23) vs. 14 days (5–38). 67% of non-adherent patients used oral prednisone which is significantly higher (p<0.001) than 54% in the adherent cohort.ConclusionsThe results of this large population based study have shown that RA patients who are adherent to biologic therapy have lower heathcare resource use and lower steroid use compared to non-adherent patients. Despite the inherent limitations of administrative database studies, the findings of the study have implications for physicians, patients and healthcare payers demonstarting the importance of adherence in the management of RA.Disclosure of InterestNone declared