Prescriber preference for a particular tumour necrosis factor antagonist drug and treatment discontinuation: population-based cohort

Abstract

ObjectiveTo assess the effect of physician preference for a particular tumour necrosis factor α (TNF) antagonist on the risk of treatment discontinuation in rheumatoid arthritis.DesignPopulation-based cohort study.SettingBritish Columbia administrative health data (inpatients, outpatients and pharmacy).Participants2742 British Columbia residents who initiated a first course of a TNF antagonist between 2001 and December 2008, had been diagnosed with rheumatoid arthritis, and were treated by 1 of 58 medium-volume to high-volume prescribers.Independent variableA level of physician preference for the drug (higher or lower) was assigned based on preceding prescribing records of the care-providing physician. Higher preference was defined as at least 60% of TNF antagonist courses initiated in the preceding year. Sensitivity analysis was conducted with different thresholds for higher preference.Main outcome measureDrug discontinuation was defined as a drug-free interval of 180 days or switching to another TNF antagonist, anakinra, rituximab or abatacept. The risk of discontinuation was compared between different levels of physician preference using survival analysis.ResultsHigher preference for the prescribed TNF antagonist was associated with improved persistence with the drug (4.28 years (95% CI 3.70 to 4.90) vs 3.27 (2.84 to 3.84), with log rank test p value of 0.017). The adjusted HR for discontinuation was significantly lower in courses of drugs with higher preference (0.85 (0.76 to 0.96)). The results were robust in a sensitivity analysis.ConclusionsHigher physician preference was associated with decreased risk of discontinuing TNF antagonists in patients with rheumatoid arthritis. This finding suggests that physicians who strongly prefer a specific treatment help their patients to stay on treatment for a longer duration. Similar research on other treatments is warranted.

Real-world evaluation of TNF-inhibitor utilization in rheumatoid arthritis

“…Patients did not need to complete the 180-day gap before the end of the 12month post-index period to be classified as discontinuing therapy. Use of a 180-day gap is consistent with other published studies [25][26][27][28] and unlike studies with shorter gaps, we did not use days' supply, rather time between prescriptions and administrations.…”

The impact of patient heterogeneity and socioeconomic factors on abatacept retention in rheumatoid arthritis across nine European countries

“…We can only hypothesise how socioeconomic features may affect drug retention. It could have to do with regulatory issues relating to access to bDMARDs (cost of drugs, administrative burdens, reimbursement concerns, physician's right to prescribe bDMARDs), local guidelines, local physician preferences 16 or other factors affecting the ease of bDMARD switching, patient and physician's expectations, or the number of available treatment choices. The fact that the drug investigated in this study was ABA rather than a TNF inhibitor may have amplified differences across countries, as ABA is mostly used as a second-line bDMARD.…”

Cost-Effectiveness of Sarilumab Added to Methotrexate in the Treatment of Adult Patients with Moderately to Severely Active Rheumatoid Arthritis Who Have Inadequate Response or Intolerance to Tumor Necrosis Factor Inhibitors

“…[14][15][16] Nonetheless, cycling between TNFi treatments after failure with a previous TNFi remains commonplace, 5,15,[17][18][19][20][21][22][23] with a number of factors likely influencing clinical practice, including compliance with the health insurance mandate (e.g., step-edit requirement) and rheumatologist or patient preferences. 24,25 While rheumatologists have a substantial number of therapeutic options currently available for patients with RA, there is a lack of clarity on the optimal approach for patients who have inadequate response or intolerance to TNFi (TNF-IR). Therefore, further evidence to inform prescribing is warranted, and both clinical effectiveness and economic consequences of these options should be considered.…”