Drug survival of second biological DMARD therapy in patients with rheumatoid arthritis: a retrospective non-interventional cohort analysis

Wilke, Thomas; Mueller, Sebastian; Lee, Sze Chim; Májer, István; Heisen, Marieke

doi:10.1186/s12891-017-1684-0

Cited by 21 publications

(13 citation statements)

References 32 publications

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“…Our results corroborate those of previous authors, who found that non‐TNFi drugs were associated with increased treatment persistence despite being prescribed less often (5,7,9–11,38,39). Although we reported lower drug costs for adherent swappers, as in other studies (7,8,10,11), we found that other categories of costs favored TNFi cycling.…”

Section: Discussionsupporting

confidence: 92%

Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis: A Comparison of Cycling Versus Swapping Strategies

Matusevich

Duan

Zhao

et al. 2021

Arthritis Care & Research

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Objective To evaluate the sequences of tumor necrosis factor inhibitors (TNFi) and non‐TNFi used by rheumatoid arthritis (RA) patients whose initial TNFi therapy has failed, and to evaluate effectiveness and costs. Methods Using the Truven Health MarketScan Research database, we analyzed claims of commercially insured adult patients with RA who switched to their second biologic or targeted disease‐modifying antirheumatic drug between January 2008 and December 2015. Our primary outcome was the frequency of treatment sequences. Our secondary outcomes were the time to therapy discontinuation, drug adherence, and drug and other health care costs. Results Among 10,442 RA patients identified, 36.5% swapped to a non‐TNFi drug, most commonly abatacept (54.2%). The remaining 63.5% cycled to a second TNFi, most commonly adalimumab (41.2%). For subsequent switches of therapy, non‐TNFi were more common. Patients who swapped to a non‐TNFi were significantly older and had more comorbidities than those who cycled to a TNFi (P < 0.001). Survival analysis showed a longer time to discontinuation for non‐TNFi than for TNFi (median 605 days compared with 489 days; P < 0.001) when used after initial TNFi discontinuation, but no difference in subsequent switches of therapy. Although non‐TNFi were less expensive for adherent patients, cycling to a TNFi was associated with lower costs overall. Conclusion Even though patients are more likely to cycle to a second TNFi than swap to a non‐TNFi, those who swap to a non‐TNFi are more likely to persist with the therapy. However, cycling to a TNFi is the less costly strategy.

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Section: Discussionsupporting

confidence: 92%

Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis: A Comparison of Cycling Versus Swapping Strategies

Matusevich

Duan

Zhao

et al. 2021

Arthritis Care & Research

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“…In a recent study by Wu et al, assessing treatment patterns in PsA patients treated with bDMARDs (TNFi and non-TNFi) versus apremilast, authors reported a 33.3% switching rate at 2 years after treatment initiation in the bDMARDs cohort 15 the switching rate among PsA patients was 32.3% at 2 years in the current study. Similarly, the one year switching rate found in the current study among the subsample of RA patients (21.9%) is also generally in line with the rates reported in the literature, ranging between 11 and 18%, although closer to the upper end of the spectrum [19][20][21] .…”

Section: Discussionsupporting

confidence: 91%

Treatment patterns and sequencing in patients with rheumatic diseases: a retrospective claims data analysis

Gauthier

Levin

Vekeman

et al. 2021

Current Medical Research and Opinion

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Objectives: Long-term real-world management of inflammatory rheumatic diseases remains unclear, especially with the advent of new treatment options. This study characterizes the number of advanced treatments used by patients with selected rheumatic diseases (rheumatoid arthritis [RA], psoriatic arthritis [PsA], ankylosing spondylitis, juvenile idiopathic arthritis) and provides a contemporary portrait of treatment patterns and therapeutic sequencing among patients with RA and PsA. Method: Patients were selected from a large US claims database and classified into disease subsamples based on the latest rheumatic diagnosis recorded before/on the day of initiation of the first advanced treatment (index date). The total number of advanced treatments was assessed within the first 5 years following the index date. Treatment patterns and therapeutic sequencing were assessed over the first 2 years. Results: Approximately 20% of patients received !2 distinct advanced treatments during the first year following index datethe proportion increased to almost 50% among patients with 5 years of observation. Most patients (RA: 76.8%; PsA: 88.7%) initiated a tumor necrosis factor as the first advanced treatment. Over the first 2 years after the index date, 1/3 of RA and PsA patients switched to another advanced treatment. More than 50% initiated a second treatment with the same mechanism of action (MOA). A small proportion of patients received a biosimilar. Conclusion: Despite advent of treatments with different MOA, cycling between treatments with the same MOA was common. Further studies with longer data follow-up would be needed to assess the impact of higher adoption of biosimilars on treatment patterns/sequencing.

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“…Retention rates of second and third b/tsDMARDs are more difficult to compare with our current study, as there are few studies that have analysed similar data. Two available studies on RA have reported results similar to ours with second b/tsDMARD (TNFi) retention rates of 46–56% ( 50 ) and 56.8% ( 51 ). In the latter study, the TNFi (vs. non-TNFi) group had a lower rate (53.5 vs. 66.7%) and retention was similar for different episodes of use.…”

Section: Discussionsupporting

confidence: 86%

Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

et al. 2021

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Aims: To determine real-life biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.Methods: Time-to-event analysis for mean treatment duration (estimated as the Restricted Mean Survival Time), b/tsDMARD failure, and b/tsDMARDs switching was performed for 230 patients (n = 147 RA, 46 PsA, 37 AS) who commenced their first b/tsDMARD between 2008 and 2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of b/tsDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. Treatment retention data was compared to a historical analysis (2002–2008).Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third b/tsDMARDs across all patients (p = 0.46). When compared to RA patients, the risk of b/tsDMARD failure was halved in PsA patients [Hazard Ratio (HR) = 0.50], but no different in AS patients (HR = 1.0). The respective restricted mean (95%CI) treatment durations, estimated at 5 years of follow-up, were 3.1 (2.9, 3.4), 4.1 (3.7, 4.6), and 3.3 (2.8, 3.9) years, for RA, PsA, and AS, respectively. Age, gender, disease duration, smoking status and the use of concomitant csDMARDS were not associated with the risk of bDMARD failure. The most common reasons for switching in the first and subsequent years were secondary (n = 62) and primary (n = 35) failure. Comparison with historical data indicated no substantive differences in switching of the first biologic for RA and PsA.Conclusion: Similar retention rates of the second and third compared to the first b/tsDMARD in RA, PsA, and AS support a strategy of differential b/tsDMARDs use informed by patient presentation. Despite greater availability of b/tsDMARDs with differing mechanisms of action, retention rates of the first b/tsDMARD remain similar to previous years.

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Drug survival of second biological DMARD therapy in patients with rheumatoid arthritis: a retrospective non-interventional cohort analysis

Cited by 21 publications

References 32 publications

Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis: A Comparison of Cycling Versus Swapping Strategies

Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis: A Comparison of Cycling Versus Swapping Strategies

Treatment patterns and sequencing in patients with rheumatic diseases: a retrospective claims data analysis

Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

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