Treatment persistence among patients with rheumatoid disease (RA, AS, PsA) treated with subcutaneous biologics in Germany

Abstract

Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) are frequently treated with subcutaneous biologic therapies when disease progresses or when response to synthetic disease-modifying antirheumatic drugs (DMARDs) is inadequate. This study analyzed treatment persistence and treatment patterns for RA, AS, and PsA patients in Germany initiating subcutaneous biologic therapies with and without prior DMARDs use. A retrospective cohort study was conducted using the Electronic Medical Record database of IMS Disease Analyzer, Germany. Patients who were ≥18 years old; had at least one ICD-10 diagnosis code of RA, AS, or PsA during the study period; and had exposure to a subcutaneous biologic agent between January 1, 2009 and June 30, 2012 were selected. Patients were required to have continuous observation ≥12 months prior to and after index medication date. Persistence was defined as consecutive days from treatment initiation until treatment discontinuation (≥60-day lapse in medication coverage). Patients were stratified by pre-index use of DMARDs. Kaplan-Meier analysis was conducted to assess time to discontinuation, and logistic regression was conducted to identify characteristics associated with persistence. A total of 576 RA, 108 AS, and 197 PsA patients without biologic experience during the pre-index period were selected. The percentages of RA, AS, and PsA patients persistent ≥12 months were 51.9, 48.1, and 57.9 %, respectively. Median persistent time over 12 months was 365.0 days for RA (mean 245.9 days), 281.0 for AS (mean 228.5), and 365.0 for PsA (mean 264.1). In the RA cohort, a significantly higher proportion of those with pre-index DMARD use were persistent compared to those without pre-index DMARD (56.1 vs. 33.3 %, p = 0.0001). No significant differences were observed for the AS and PsA cohorts. Multivariate analyses confirmed that DMARD-experienced patients were 2.45 times more likely to be persistent with subcutaneous biologic therapy in the RA cohort. Switching between subcutaneous biologics occurred in <10 % of patients in all three cohorts. In the subpopulations with at least two prescriptions for the index subcutaneous biologic and who remained persistent on the index subcutaneous biologic, dose escalation of ≥50 % occurred in 50, 60, and 49 % in the RA, AS, and PsA cohorts, respectively. Among RA, AS, and PsA patients newly initiating subcutaneous biologic agents in Germany, persistence at 12 months is relatively low (48-58 %). For the RA cohort, patients with pre-index DMARD use are more persistent than patients without. The majority of patients do not switch between subcutaneous biologics. A notable proportion of patients who remained persistent on their index subcutaneous biologic had a dose escalation. There are opportunities to improve outcomes of patient with rheumatoid disease through improved medication persistence.

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

“…Patient and physician global disease assessments are combined with 28 swollen and tender joint counts to calculate the Clinical Disease Activity Index (CDAI) from 0 to 76, where < 2.9 is remission, 2.9-10.0 low disease activity, 10.1-22.0 moderate disease activity, and > 22.0 high disease activity [14]. Disease Activity in Psoriatic Arthritis (DAPSA) scores are calculated from joint counts (68 tender/66 swollen), CRP, and patient assessments of disease activity and pain, yielding scores consistent with remission (0-4) or mild (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), moderate (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), or high (> 28) disease activity [15]. Patients use the Work Productivity and Activity Impairment questionnaire to report the effect of PsA/SpA on work (percentage of hours missed, impairment while at work, and work hours affected) and daily activities [16][17][18].…”

Persistence with Biologic Agents for the Treatment of Rheumatoid Arthritis in Japan

“…Most studies are either from Europe [7][8][9][10][11][12][13][14][15][16] or North America, [17][18][19][20][21][22][23] while studies in Asian populations are scarce. Apart from two Korean studies, 24,25 one Japanese prospective cohort study was identified that analyzed patients who started biologic treatment with infliximab, etanercept, or tocilizumab.…”

The Duality of Economic Issues With Medication Non-adherence in Patients With Inflammatory Arthritis

“…Among these, 20% of discontinuations were the patients' decision with reasons including low level of pain, self-administration of biologics, negative beliefs about treatment, and lack of medical and social support. Finally, Lyu's 2016 study from Germany used electronic medical records to study persistence to subcutaneous biologic therapies among patients with rheumatic disease including 108 patients with AS (36). They reported 1-year discontinuation of 51.9% with mean treatment duration of 228.5 days (36).…”

“…Finally, Lyu's 2016 study from Germany used electronic medical records to study persistence to subcutaneous biologic therapies among patients with rheumatic disease including 108 patients with AS (36). They reported 1-year discontinuation of 51.9% with mean treatment duration of 228.5 days (36).…”

“…Pauses in therapy and therapy discontinuation were common, but more than 40% of patients restarted their index anti-TNF after discontinuation(50). Finally, Lyu's 2016 study in Germany using an electronic medical record database including 197 PsA patients found that 42.1% of patients discontinued their anti-TNF therapies within 1 year with mean treatment duration of 264.1 days(36).…”