The Impact of the Amendment of the Korean National Health Insurance Reimbursement Criteria for Anti-tumor Necrosis Factor-α Agents on Treatment Pattern, Clinical Response and Persistence in Patients With Rheumatoid Arthritis

Abstract

Objective. To investigate the impact of the amendment of the Korean National Health Insurance (KNHI) reimbursement criteria for anti-tumor necrosis factor-α (TNF-α) agents based on from conventional clinical and laboratory measurements to disease activity score of 28 joints (DAS28) on treatment pattern, clinical response, and persistence rate in patients with rheumatoid arthritis (RA). Methods. This multicenter retrospective cohort study evaluated 148 RA patients eligible for the initiation of anti-TNF-α agents as the first-line biologics by either the past (n=95) or current (n=53) KNHI reimbursement criteria. Persistence was defined as the duration between the initiation and discontinuation of anti-TNFα agents. Results. In total, 106 (71.6%), 35 (23.6%), and 7 (4.7%) RA patients started treatment with adalimumab, etanercept, and infliximab, respectively. RA patients who received anti-TNF-α agents under the current reimbursement criteria had a significantly lower mean DAS28-erythrocyte sedimentation rate (ESR) (6.02 vs. 6.95, p＜0.001) and daily prednisolone-equivalent glucocorticoid dose (4.51 vs. 6.17 mg, p＜0.001) than those who received anti-TNF-α agents under the past reimbursement criteria. No significant differences in the 1-year remission rate defined by p=0.085) and the persistence rate (p=0.703) between the past and current reimbursement criteria was observed. Conclusion. Our data suggest that less active RA patients can receive reimbursement for anti-TNF-α agents under the current criteria, and the amendment of the KNHI reimbursement criteria may improve access to anti-TNF-α agents without affecting the treatment response and persistence rate.

Machine learning-based prediction model for responses of bDMARDs in patients with rheumatoid arthritis and ankylosing spondylitis

“…A few months are required to determine the efficacy of the medications. Non-responders could experience high drug costs, unimproved disease conditions, and side effects during this period [ 6 – 9 ]. Therefore, methods to predict the responses prior to the start of bDMARDs is garnering substantial interest.…”

Medication utilisation trends during pregnancy and factors influencing adverse pregnancy outcomes in patients with rheumatoid arthritis

“…To initiate targeted therapy, patients with RA must have been treated with at least two types of csDMARDs, including MTX, for more than 3 months each. 22 MTX must be included if a patient does not have any serious adverse event after MTX treatment, and planning for pregnancy is not admitted as an appropriate reason for skipping MTX. Because MTX is stopped in advance of preparing for pregnancy, it is inevitably more difficult for young female patients to initiate targeted therapy.…”

Association of Tumor Necrosis Factor Inhibitors with the Risk of Nontuberculous Mycobacterial Infection in Patients with Rheumatoid Arthritis: A Nationwide Cohort Study

“…Moreover, this study evaluated the long-term effect of TNFi by including patients who underwent TNFi therapy for a minimum of six months while maintaining good medication adherence, with all patients using TNFi having a PDC greater than or equal to 0.8. In actual real-world clinical settings, TNFi is typically used for the long term in patients with RA, with a median treatment duration of 26 months in Korea [48]. Also, in Korea, the median duration from initiation of TNFi to the development of NTM infection has been reported to be approximately 29.4 months [23].…”