Characteristics Associated with Biologic Monotherapy Use in Biologic-Naive Patients with Rheumatoid Arthritis in a US Registry Population

Abstract

IntroductionThe aim of this study was to describe factors associated with initiating a biologic as monotherapy vs in combination with a conventional disease-modifying antirheumatic drug (DMARD) in biologic-naive patients with rheumatoid arthritis (RA) enrolled in the Corrona registry.MethodsFirst biologic initiations were classified as monotherapy (Bio MT) or combination therapy (Bio CMB). Baseline demographic and clinical characteristics were evaluated. Odds ratios (OR) based on mixed effects regression models estimated the association of covariates and use of monotherapy. Median odds ratios (MOR) based on estimated physician random effects quantified variation in individual physician use of monotherapy.ResultsBetween October 2001 and April 2012, 3,923 previously biologic-naive patients initiated biologic therapy, of which 19.1 % initiated as monotherapy. Baseline characteristics of patients initiating Bio MT and Bio CMB were similar for age, sex, duration of RA, and clinical disease activity index. Significantly higher proportions of Bio CMB initiators had prior conventional DMARD (97.23 vs 85.60 %; P < 0.01) and methotrexate (MTX) use (91.68 vs 71.87 %; P < 0.01) compared with Bio MT initiators. Variation in individual physician use of monotherapy [MOR 1.89; 95 % confidence interval (CI), 1.66–2.23] and use of biologics approved by the United States Food and Drug Administration for monotherapy (OR 1.47; 95 % CI, 1.20–1.81) significantly influenced the odds of initiating Bio MT. Patient history of hepatic disease, neutropenia, and malignancy were associated with increased odds of being prescribed Bio MT.ConclusionIn addition to regulatory approval for monotherapy and specific pre-existing comorbidities, significant variation in physician use of monotherapy was associated with increased likelihood of initiating Bio MT, independent of patient factors.Electronic supplementary materialThe online version of this article (doi:10.1007/s40744-015-0008-9) contains supplementary material, which is available to authorized users.

Patient Satisfaction with Pharmacist‐Led Collaborative Follow‐Up Care in an Ambulatory Rheumatology Clinic

“…While our design did not account for all possible unmeasured confounders, when the set of measured demographics were compared for the two groups, no significant differences were present. In addition, our cohort was similar to the validation cohort (Hill et al, 1992) and other inflammatory arthritis cohorts (Bykerk et al, 2012;Pappas et al, 2015) that reported similar results. Taken together, these findings add credence to our interpretation that, despite the potential existence of uncontrolled confounders, there is a positive relationship between collaborative care models and patient satisfaction.…”

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

“…Rituximab is approved only with MTX in the USA and Europe 97 98. Two recent analyses of the CORRONA registry showed the likelihood of starting biologic monotherapy was consistently increased if it was approved for use as monotherapy 44 99. Other factors that increased the likelihood of a biologic monotherapy prescription included the patient's previous biologic experience and the rheumatologist's prescribing patterns.…”

Frequency and Factors Associated with Biologic Monotherapy in Patients with Rheumatoid Arthritis; Experience from an Argentine Center

“…In our experience we could observe that the frequency of monotherapy was 31.6%, somewhat higher than that observed in a multicentric Argentine study where the frequency was 21.4% [24]. Global records inform that the use of monotherapy varies between 12 and 39% [25,26].…”