AB0523 Lower than expected levels of DMARD acquisition immediately pre and post biologic initiation in RA patients

Abstract

Background Reports suggest that a large proportion of patients who acquire and use biologic DMARD agents (biologics) to treat Rheumatoid Arthritis (RA) do not acquire or adequately consume traditional DMARDs (DMARDs)(1,2). However acquisition rates of biologics and DMARDs at the point of biologic initiation remains to be determined. Objectives Exploration of the level of DMARD acquisitions in Canadian RA patients in the 6 to 12 months both immediately prior to and post-biologic initiation to quantify the levels of biologic monotherapy vs. biologic + DMARD combination consumption. Methods Biologic and DMARD concomitant therapy based on actual patient purchases was examined by tracking a cohort of 1,652 anonymous RA patient records from public and private drug plans in Canada (ON, QC) via unique drug plan identifier numbers (3rd party source).(3) All patients who were initiated on a biologic between August 2009 and July 2010 were tracked for a one-year period prior to and post their biologic initiation date. All cohort patients were compliant on biologics post initiation. Rheumatologist prescribing frequencies of RA therapies were assessed through randomly recruited surveys (n=100).(4) Results Physicians prescribed a biologic without a DMARD only 12% of the time(4). 25% of cohort patients did not purchase any form of DMARD within the 6 months prior to starting a biologic (41% for MTX). 29% did not acquire DMARDs at any point in the 6 months post-biologic initiation (43% for MTX). Data 12 months pre-biologic initiation showed that 22% did not acquire DMARDs (37% for MTX). Data 12 months post-biologic initiation showed that 26% did not acquire DMARDs (41% for MTX).(3) Prescriptions supplied to 2-3 months worth of drug.(4) Conclusions A large proportion of Canadian patients do not acquire any form of DMARD in the 6-12 months prior to being initiated on a biologic for the first time. This may negatively influence compliance on DMARDs once a biologic is initiated. Registries suggest this, as 6 months post-biologic initiation, 29% do not acquire any form of DMARD (43% for MTX) despite the general physician prescribing rate of biologic monotherapy (12%).(3,4) These results are consistent with other registries, however this study isolates biologic monotherapy levels immediately prior to and post-biologic initiation.(1,2,3) Many patients report reluctance or refusal to take DMARDs due to side effects that include headache, GI discomfort, malaise, fatigue, nausea, hair loss, and lifestyle restrictions(4,5). Close monitoring of DMARD intake is recommended and/or management of patients on monotherapy. Patient education is of prime importance as sustainability, clinical and radiological efficacy of biologic treatment will be compromised. References Choquette et al., Large discrepancy between expected and observed ratios of biologic treated Rheumatoid Arthritis patients also compliant on DMARDs, ACR congress abstract 2010 Soliman MM, et al., Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in p...

Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis

“…Another analysis of 1652 patient records from Canadian private and public drug plans (2009–2010) demonstrated a biologic monotherapy prescribing rate of 12%; however, 29% of patients (43% of those prescribed MTX) did not obtain their DMARD within 6 months after starting biologic therapy. 64 …”

Biologic monotherapy in the treatment of rheumatoid arthritis

“…High-cost biological treatments (biological DMARDs, bDMARDs) are usually reserved for use if csDMARDs are ineffective and contraindicated, and in cases of nonresponse, drug-induced adverse events (AEs), or bad compliance of patient ( Figure 1 ). 5 – 7 , 9 …”

Adherence to Methotrexate in Rheumatoid Arthritis: A Danish Nationwide Cohort Study

“…Real-life registry data indicate that patients to a larger extent remain on antirheumatic biologic agents when given in combination with MTX [ 7 ]. However, preliminary Canadian healthcare data indicate that when MTX is prescribed in conjunction with a biologic agent, more than half of the patients do not collect their MTX prescription [ 8 , 9 ]. If these estimates are justified, the clinical practice guidelines could be in conflict with the item accepted unanimously by the “treat-to-target” task force stating that “ the treatment of RA must be based on a shared decision between patient and rheumatologist ” [ 4 ].…”