Biologic and Targeted Synthetic DMARD Utilization in the United States: Adelphi Real World Disease Specific Programme for Rheumatoid Arthritis

Abstract

Introduction: In patients with inadequate response or intolerance to first biologic diseasemodifying antirheumatic drug (bDMARD), guidelines recommend switching to an agent of different mechanism of action or to another bDMARD. However, the reasons behind switching between bDMARD/targeted synthetic (ts)DMARD are not well documented in many studies. The objective of this study was to assess the rheumatologists' perceptions and behaviors towards choice of initial b/tsDMARD treatment and reasons for switching between bDMARDs/tsDMARDs, in the context of present treatment patterns.Methods: This was a retrospective analysis of data collected from the 12th Adelphi Real World Disease Specific Programme for rheumatoid arthritis (RA). Qualified rheumatologists involved in treatment decision-making for C 10 patients a month completed patient record forms (PRFs). Patients aged C 18 years with RA diagnosis and receiving bDMARD/tsDMARD were included. The outcomes assessed were proportion of patients receiving bDMARD/tsDMARD at molecule and class levels; rheumatologist-reported reasons for choice of therapy; proportion of patients who switched bDMARDs/tsDMARDs; and rheumatologist-reported reasons for switching therapies. Results: Eighty-six rheumatologists completed PRFs for 1027 patients. Of these, 621 were receiving bDMARD/tsDMARD at data collection. The majority (73%) of patients received first-line bDMARD/tsDMARD, and at first-line, 68% received a tumor necrosis factor inhibitor (TNFi) and 21% received a Janus kinase inhibitor (JAKi). The response option of strong overall efficacy was the primary reason for selecting first-line and second-line bDMARD/ tsDMARD. A total of 163 patients had switched from first-line b/tsDMARD to second-line b/tsDMARD therapy. Of these, 44, 28, and 17% had switched from TNFi to another TNFi, TNFi to non-TNF biologic, and TNFi to JAKi, respectively. Lack of efficacy and worsening disease were the most frequent reasons for switching therapies.

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“…bDMARDs and targeted sDMARDs (tsDMARDs) tend to work faster than csDMARDs. 20,21) However, bDMARDs are expensive and approximately 40% of RA patients do not respond to therapy using anti-TNF-α antibodies, a representative bDMARD. In addition, currently available tsDMARDs are limited to inhibitors of Janus kinases (JAK), which are associated with concerns about increased susceptibility to viral infection.…”

Demographic and Clinical Characteristics of Patients with Sustained and Switching Treatments Using Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs: A Multicenter, Observational Cross-Sectional Study for Rheumatoid Arthritis

“…Furthermore, we have detected that the patients with sustained therapies were more frequently male; they had lower composite disease activity scores, lower hematologic manifestations, lower and 9% after two switching cycles. However, the rates were about 5% for each agent in the overall analyses [12]. Biologic registries are essential sources for real-life data and long-term safety results.…”

“…The rate to use tocilizumab and rituximab was lower among individuals with first-line advanced therapy, reaching 20% and 9% after two switching cycles. However, the rates were about 5% for each agent in the overall analyses [ 12 ].…”

“…This system collects the course of RA in Turkey and monitors the treatment applications in RA patients. It is known that physicians’ treatment decisions regarding advanced therapies of RA patients are commonly affected by the patient’s clinical factors, whereas healthcare policy is also regarded [ 12 ]. In this context, the analyses from this cohort will aid in identifying the treatment sequences and reasons for switching in RA patients receiving bDMARD/tsDMARD in a real-world setting.…”

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“…Newer bDMARDs, with various modes of action, can be administered to RA patients who are unresponsive to TNF-inhibitor treatment [ 54 ]. For instance, abatacept (ABT, which interrupts the costimulation molecule signal between T and B cells) [ 55 ], rituximab (RTX, which targets CD20 + B cells) [ 56 ], and tocilizumab (TCZ, which is an IL-6 receptor (IL-6R) antagonist) [ 57 ] have demonstrated high treatment efficacy in patients with active RA, particularly in those with inadequate responses to TNF-inhibitor treatment [ 58 ].…”