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Jones G, Calao M, Begun J, Sin S, Kouhkamari MH, Young E, Fernández-Peñas P, Watts A, Östör AJ. Impact of a Patient Support Program on time to discontinuation of adalimumab in Australian adult patients with immune-mediated inflammatory diseases-an observational study. PLoS One 2024; 19:e0300624. [PMID: 38870244 PMCID: PMC11175455 DOI: 10.1371/journal.pone.0300624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/02/2024] [Indexed: 06/15/2024] Open
Abstract
This observational study evaluated the impact of a sponsor company-provided Patient Support Program (PSP) on discontinuation of adalimumab in adult Australian patients eligible for Pharmaceutical Benefit Scheme (PBS)-reimbursed adalimumab for Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Crohn's Disease (CD), Ulcerative Colitis (UC), or Hidradenitis Suppurativa (HS). Patients initiating adalimumab between May 2018 and September 2019 were enrolled into two prospective cohorts based on their decision to opt for or decline the PSP (PSP or non-PSP cohorts). In addition, a historical, retrospective Non-PSP cohort was established from the Services Australia 10% PBS dataset by extracting data of patients initiating adalimumab prior to the introduction of adalimumab PSPs and based on adalimumab PBS listing dates (AS: April 2007 to March 2009; PsA/RA: January 2007 to December 2008; CD: January 2009 to December 2010; HS and UC indications not included). Follow-up for all cohorts was 12 months. The primary endpoint was the time to discontinuation, compared between the prospective PSP cohort and the prospective or retrospective Non-PSP cohort. Inverse probability of treatment weighting was used to balance the cohorts. A Cox proportional hazards model indicated no difference in time to discontinuation between the prospective PSP (n = 162) and non-PSP (n = 65) cohorts (HR [95% CI] = 1.256 [0.616-2.563], p = 0.5304). The 12-month adalimumab persistence rates (95% CI) were 78% (69%, 84%) and 82% (67%, 90%), respectively. In contrast, discontinuation was less likely in the prospective PSP (n = 151) compared with the retrospective non-PSP (n = 297) cohort (HR [95% CI] = 0.44 [0.28-0.68], p<0.001). The 12-month persistence rates (95% CI) were 81% (76%, 90%) and 61% (56%, 67%), respectively. Overall, this study suggests that optimal adalimumab persistence can be achieved with either a structured PSP or healthcare support from other sources, but this was not the case more than a decade ago.
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Affiliation(s)
- Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Miriam Calao
- Abbvie Pty Ltd, Mascot, New South Wales, Australia
| | - Jakob Begun
- Mater Research, Brisbane, QLD, Australia
- Department of Gastroenterology, Mater Hospital, Brisbane, QLD, Australia
| | - Shirley Sin
- Abbvie Pty Ltd, Mascot, New South Wales, Australia
| | | | - Elisa Young
- Southern Star Research Pty Ltd, Gordon, Australia
| | - Pablo Fernández-Peñas
- Department of Dermatology, The University of Sydney, Westmead Hospital, Sydney, Australia
| | - Alan Watts
- Abbvie Pty Ltd, Mascot, New South Wales, Australia
| | - Andrew J. Östör
- Melbourne and ANU, Canberra & Emeritus Research, Monash University, Melbourne, Australia
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The beneficial effect of csDMARDs co-medication on drug persistence of first-line TNF inhibitor in rheumatoid arthritis patients: data from Czech ATTRA registry. Rheumatol Int 2022; 42:803-814. [PMID: 35338383 PMCID: PMC9007799 DOI: 10.1007/s00296-021-05072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/15/2021] [Indexed: 10/31/2022]
Abstract
The study aimed to compare treatment retention for first-line TNF inhibitor (TNFi) in the ATTRA registry patients receiving either combination with conventional synthetic DMARDs or TNFi as monotherapy. A retrospective multicenter study analyzed data of all adult patients with rheumatoid arthritis (n = 3032) starting TNF inhibitor as the first-line biological therapy in combination with csDMARDs or in monotherapy from January 1st 2012 to December 31st 2020. Kaplan-Meier method was employed to calculate drug retentions. Survival curves of treatment retentions were compared through Log-rank test between the studied subgroups. The hazard ratio for drug discontinuation was assessed through univariate cox regression models. In patients who started the first line TNFi therapy, the median treatment retention was 47.7 (42.2; 53.1) months for combination therapy and 22.7 (14.9; 30.6) months for TNFi monotherapy (p < 0.001). Estimated one-year survival was higher in patients on TNFi combined with csDMARDs as compared with TNFi monotherapy (75.3% vs 65.7%); two-year survival rate was 63.2% vs 49.2%, three-year survival rate was 55.4% vs 42.4% and five-year survival 44.9% vs 26.4% of patients. The estimated survival on the first TNFi was higher in patients taking combination therapy with methotrexate than with other csDMARDs (p = 0.003). Use of csDMARDs co-medication was associated with significantly better first TNFi drug survival compared to monotherapy. The combination of TNFi with MTX is more effective than the combination with leflunomide, which did not demonstrate a significant effect.
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Efficacy and Drug Survival after Switching from Etanercept to the Biosimilar SB4: A Real-Life Long-Term Study. J Clin Med 2022; 11:jcm11030621. [PMID: 35160074 PMCID: PMC8837069 DOI: 10.3390/jcm11030621] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
We evaluated the 3-year drug survival and efficacy of the biosimilar SB4/Benepali in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients, previously treated with etanercept (ETA). Drug survival rate was calculated using the Kaplan–Meier method and Cox proportional hazard models were developed to examine predictors of SB4 discontinuation. 236 patients (120 RA, 80 PsA and 36 AS), aged 60.7 ± 13.8 years and with an ETA duration of 4.1 ± 3.4 years were included. The 3-year retention rate for SB4 was 94.4%, 88% and 86% in AS, RA and PsA patients, respectively, with no difference between groups. Patients without comorbid disease had higher retention rates vs. patients with comorbid disease (90% vs. 60%, p < 0.0001). Disease activity, as measured by DAS28, DAPSA and BASDAI remained stable over the 3 years. Comorbid disease (hazard ratio; HR: 4.06, p < 0.0001) and HAQ at baseline (HR: 2.42, p = 0.0024) significantly increased the risk of SB4 discontinuation, while previous ETA duration was negatively associated with SB4 discontinuation (HR: 0.97, p = 0.0064). Forty-one (17.4%) patients left the study due to the interruption of the SB4 treatment, 31 (75.6%) discontinued due to inefficacy and 10 (24.4%) due to adverse events. This real-life study confirms the similar efficacy profile of ETA with long-term retention and a good safety profile in inflammatory arthritis patients.
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Jung SM, Lee SW, Song JJ, Park SH, Park YB. Drug Survival of Biologic Therapy in Elderly Patients With Rheumatoid Arthritis Compared With Nonelderly Patients: Results From the Korean College of Rheumatology Biologics Registry. J Clin Rheumatol 2022; 28:e81-e88. [PMID: 33337811 DOI: 10.1097/rhu.0000000000001644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although the proportion of elderly patients with rheumatoid arthritis (RA) is increasing, the persistency of biologic therapy in elderly patients requires additional investigation. This study evaluated the drug survival of biologic therapy and associated factors in elderly compared with nonelderly patients. METHODS This longitudinal observational study included RA patients who were enrolled in the Korean College of Rheumatology Biologics Registry (NCT01965132, started from January 1, 2013) between 2013 and 2015. We compared the retention rate of biologic therapy between elderly (age ≥70 years) and nonelderly (age <70 years) patients, and investigated the causes and predictors of biologic withdrawal in both groups. RESULTS Of 682 patients, 122 were aged 70 years or older. The retention rate of biologic therapy at 24 months was 57.8% and 46.5% in nonelderly and elderly patients, respectively (p = 0.027). Biologic withdrawal due to adverse events and inefficacy within 24 months was not significantly different between the 2 groups, although adverse events were more common in elderly patients (20.6% vs 12.8%, p = 0.360). Drug withdrawal due to patient refusal was more common in elderly patients (9.8% vs 1.8%, p < 0.001). In elderly patients, biologic withdrawal was associated with current smoking and older age at disease onset, whereas the use of tumor necrosis factor inhibitors, nonuse of methotrexate, and combination of corticosteroid were important in nonelderly patients. CONCLUSIONS Elderly RA patients are more likely to discontinue biologic agents within 24 months. To increase the retention rate of biologic therapy, rheumatologists should consider patient characteristics before and during biologic therapy.
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Affiliation(s)
| | - Sang-Won Lee
- From the Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine
| | - Jason Jungsik Song
- From the Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Beom Park
- From the Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine
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Pombo-Suárez M, Sanchez-Piedra C, Ruiz-Montesino D, Diaz-Torne C, Jovaní V, Cea-Calvo L, Castrejón I. Retention of golimumab treatment following discontinuation of non-TNF inhibitors in patients with inflammatory rheumatic diseases: An analysis of the Spanish BIOBADASER registry. Musculoskeletal Care 2021; 20:403-407. [PMID: 34668303 DOI: 10.1002/msc.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Manuel Pombo-Suárez
- Servicio de Reumatología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Cesar Diaz-Torne
- Servicio de Reumatología, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Vega Jovaní
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Isabel Castrejón
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Bhushan V, Lester S, Briggs L, Hijjawi R, Shanahan EM, Pontifex E, Ninan J, Hill C, Cai F, Walker J, Goldblatt F, Wechalekar MD. Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. Front Med (Lausanne) 2021; 8:708168. [PMID: 34646840 PMCID: PMC8502861 DOI: 10.3389/fmed.2021.708168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Vandana Bhushan
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,Division of Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Susan Lester
- Rheumatology Unit, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Liz Briggs
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - Raif Hijjawi
- Division of Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - E Michael Shanahan
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Eliza Pontifex
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jem Ninan
- Rheumatology Unit, Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Catherine Hill
- Rheumatology Unit, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Fin Cai
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Fiona Goldblatt
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Mihir D Wechalekar
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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7
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Karpes Matusevich AR, Duan Z, Zhao H, Lal LS, Chan W, Suarez-Almazor ME, Giordano SH, Swint JM, Lopez-Olivo MA. Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis: A Comparison of Cycling Versus Swapping Strategies. Arthritis Care Res (Hoboken) 2021; 73:1461-1469. [PMID: 32558339 DOI: 10.1002/acr.24358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
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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Affiliation(s)
| | - Zhigang Duan
- The University of Texas MD Anderson Cancer Center, Houston
| | - Hui Zhao
- The University of Texas MD Anderson Cancer Center, Houston
| | - Lincy S Lal
- School of Public Health, The University of Texas Health Science Center at Houston
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston
| | | | | | - J Michael Swint
- School of Public Health and McGovern School of Medicine, The University of Texas Health Science Center at Houston
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8
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Anchang CG, Xu C, Raimondo MG, Atreya R, Maier A, Schett G, Zaburdaev V, Rauber S, Ramming A. The Potential of OMICs Technologies for the Treatment of Immune-Mediated Inflammatory Diseases. Int J Mol Sci 2021; 22:ijms22147506. [PMID: 34299122 PMCID: PMC8306614 DOI: 10.3390/ijms22147506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 01/08/2023] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel diseases and inflammatory arthritis (e.g., rheumatoid arthritis, psoriatic arthritis), are marked by increasing worldwide incidence rates. Apart from irreversible damage of the affected tissue, the systemic nature of these diseases heightens the incidence of cardiovascular insults and colitis-associated neoplasia. Only 40–60% of patients respond to currently used standard-of-care immunotherapies. In addition to this limited long-term effectiveness, all current therapies have to be given on a lifelong basis as they are unable to specifically reprogram the inflammatory process and thus achieve a true cure of the disease. On the other hand, the development of various OMICs technologies is considered as “the great hope” for improving the treatment of IMIDs. This review sheds light on the progressive development and the numerous approaches from basic science that gradually lead to the transfer from “bench to bedside” and the implementation into general patient care procedures.
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Affiliation(s)
- Charles Gwellem Anchang
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany; (C.G.A.); (C.X.); (M.G.R.); (G.S.); (S.R.)
| | - Cong Xu
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany; (C.G.A.); (C.X.); (M.G.R.); (G.S.); (S.R.)
| | - Maria Gabriella Raimondo
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany; (C.G.A.); (C.X.); (M.G.R.); (G.S.); (S.R.)
| | - Raja Atreya
- Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany;
| | - Andreas Maier
- Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Georg Schett
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany; (C.G.A.); (C.X.); (M.G.R.); (G.S.); (S.R.)
| | - Vasily Zaburdaev
- Max-Planck-Zentrum für Physik und Medizin, 91054 Erlangen, Germany;
- Department of Biology, Mathematics in Life Sciences, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Simon Rauber
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany; (C.G.A.); (C.X.); (M.G.R.); (G.S.); (S.R.)
| | - Andreas Ramming
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum, 91054 Erlangen, Germany; (C.G.A.); (C.X.); (M.G.R.); (G.S.); (S.R.)
- Correspondence: ; Tel.: +49-9131-8543048; Fax: +49-9131-8536448
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9
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Prior-Español A, Sánchez-Piedra C, Campos J, Manero FJ, Pérez-García C, Bohórquez C, Busquets-Pérez N, Blanco-Madrigal JM, Díaz-Torne C, Sánchez-Alonso F, Mateo L, Holgado-Pérez S. Clinical factors associated with discontinuation of ts/bDMARDs in rheumatic patients from the BIOBADASER III registry. Sci Rep 2021; 11:11091. [PMID: 34045525 PMCID: PMC8159943 DOI: 10.1038/s41598-021-90442-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/12/2021] [Indexed: 01/14/2023] Open
Abstract
Biologic and targeted synthetic disease-modifying antirheumatic drugs (ts/bDMARDs) play a pivotal role in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Persistence of therapy provides an index of a drug’s overall effectiveness. The objective of the study was to identify factors associated with discontinuation of ts/bDMARDs in a real-world dataset. The study population comprised patients diagnosed with RA, PsA, and AS included in the BIOBADASER registry for whom follow-up data were available until November 2019. Patient features and treatment data were included in the analysis. The Kaplan–Meier method was used to study survival of the different drugs according to the reason for discontinuation. Factors associated with discontinuation were studied using Cox regression models and bivariate and multivariate analyses. P values of less than 0.05 were regarded as statistically significant. The study population comprised 4,752 patients who received a total of 8,377 drugs, of which 4,411 (52.65%) were discontinued. The Kaplan–Meier curves showed that survival for first-line treatment was greater in all 3 groups (p < 0.001). Patients with RA had a greater risk of discontinuation if they were younger (HR, 0.99; 95% CI 0.99–1.00), if they were receiving anti-TNFα agents (HR, 0.61; 95% CI 0.54–0.70), and if they had more comorbid conditions (HR, 1.09; 95% CI 1.00–1.17). Patients with PsA had a higher risk if they were women (HR, 1.36; 95% CI 1.15–1.62) and if they were receiving other ts/bDMARDs (HR, 1.29; 95% CI 1.05–1.59). In patients with AS, risk increased with age (HR, 1.01; 95% CI 1.00–1.02), as did the number of comorbid conditions (HR, 1.27; 95% CI 1.12–1.45). The factors that most affected discontinuation of ts/bDMARDs were line of treatment, age, type of drug, sex, comorbidity and the year of initiation of treatment. The association with these factors differed with each disease, except for first-line treatment, which was associated with a lower risk of discontinuation in all 3 diseases.
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Affiliation(s)
- A Prior-Español
- Rheumatology Unit, Hospital Universitari Germans Trias I Pujol, Carretera del Canyet, s/n, 08916, Badalona, Barcelona, Spain.
| | | | - J Campos
- Rheumatology Unit, Hospital Puerta de Hierro, Madrid, Spain
| | - F J Manero
- Rheumatology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - C Bohórquez
- Rheumatology Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - N Busquets-Pérez
- Rheumatology Unit, Hospital General de Granollers, Barcelona, Spain
| | | | - C Díaz-Torne
- Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | | | - L Mateo
- Rheumatology Unit, Hospital Universitari Germans Trias I Pujol, Carretera del Canyet, s/n, 08916, Badalona, Barcelona, Spain
| | - S Holgado-Pérez
- Rheumatology Unit, Hospital Universitari Germans Trias I Pujol, Carretera del Canyet, s/n, 08916, Badalona, Barcelona, Spain
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10
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Letarouilly JG, Salmon JH, Flipo RM. Factors affecting persistence with biologic treatments in patients with rheumatoid arthritis: a systematic literature review. Expert Opin Drug Saf 2021; 20:1087-1094. [PMID: 33926364 DOI: 10.1080/14740338.2021.1924146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Biologic treatments are a milestone in the management of rheumatoid arthritis (RA) patients with an inadequate response to conventional synthetic treatments. With the increase in the number of biologic treatments, predictor factors of discontinuation are needed to choose the right treatment for the right patient.Areas covered: In this article, the factors affecting persistence with biologic treatments will be covered: factors associated with the demographic characteristics and comordidities of the patients, those with the characteristics of the disease, the biomarkers, and the adherence.Expert opinion: Seeking factors affecting persistence with biologic treatments is an important field of clinical research to offer the best management to the RA patients. Personalized medicine is the ultimate goal in this field to choose the biological therapy with the highest persistence for every patient. To achieve this goal, biomarkers could be a milestone.
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Affiliation(s)
| | - Jean-Hugues Salmon
- Department of Rheumatology, Université De Reims Champagne-Ardenne, Reims, France
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11
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Karpes Matusevich AR, Lai LS, Chan W, Swint JM, Cantor SB, Suarez-Almazor ME, Lopez-Olivo MA. Cost-utility analysis of treatment options after initial tumor necrosis factor inhibitor therapy discontinuation in patients with rheumatoid arthritis. J Manag Care Spec Pharm 2020; 27:73-83. [PMID: 33377443 PMCID: PMC10391179 DOI: 10.18553/jmcp.2021.27.1.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: For patients with rheumatoid arthritis (RA) who discontinued initial treatment with tumor necrosis factor inhibitor (TNFi), 2 approaches are commonly used: cycling to another TNFi or switching to a drug with another mechanism of action. Currently, there is no consensus on which approach to use first. A report from the IBM MarketScan Research administrative claims database showed adalimumab (cycling strategy) and abatacept (switching strategy) were more commonly prescribed after the first TNFi discontinuation. OBJECTIVE: To evaluate the cost-utility of adalimumab versus abatacept in patients with RA whose initial TNFi therapy failed. METHODS: A probabilistic cost-utility microsimulation state-transition model was used. Our target population was commercially insured adults with RA, the time horizon was 10 years, and we used a payer perspective. Patients not responding to adalimumab or abatacept were moved to the next drug in a sequence of 3 and, finally, to conventional synthetic therapy. Incremental cost-utility ratios (2016 USD per quality-adjusted-life-year gained [QALY)] were calculated. Utilities were derived from a formula based on the Health Assessment Questionnaire Disability Index and age-adjusted comorbidity score. RESULTS: Switching to abatacept after the first TNFi showed an incremental cost of just more than $11,300 over 10 years and achieved a QALY benefit of 0.16 compared with adalimumab. The incremental cost-effectiveness ratio was $68,950 per QALY. Scenario analysis produced an incremental cost-effectiveness ratio range of $44,573 per QALY to $148,558 per QALY. Probabilistic sensitivity analysis showed that switching to abatacept after TNFi therapy failure had an 80.6% likelihood of being cost-effective at a willingness-to-pay threshold of $100,000 per QALY. CONCLUSIONS: Switching to abatacept is a cost-effective strategy for patients with RA whose discontinue initial therapy with TNFi. DISCLOSURES: Funding for this project was provided by a Rheumatology Research Foundation Investigator Award (principal investigator: Maria A. Lopez-Olivo). Karpes Matusevich's work was supported by a Doctoral Dissertation Research Award from the University of Texas, School of Public Health Office of Research. Lal reports competing interests outside of the submitted work (employed by Optum). Suarez-Almazor reports competing interests outside of the submitted work (consulting fees from Pfizer, AbbVie, Eli Lilly, Agile Therapeutics, Amag Pharmaceuticals, and Gilead). Chan, Swint, and Cantor have nothing to disclose.
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Affiliation(s)
- Aliza R Karpes Matusevich
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston
| | - Lincy S Lai
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, and Center for Clinical Research and Evidence-Based Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston
| | - J Michael Swint
- Department of Management, Policy and Community Health, School of Public Health, and Center for Clinical Research and Evidence-Based Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria E Suarez-Almazor
- Department of Health Services Research and Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
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Movahedi M, Hepworth E, Mirza R, Cesta A, Larche M, Bombardier C. Discontinuation of biologic therapy due to lack/loss of response and adverse events is similar between TNFi and non-TNFi class: Results from a real-world rheumatoid arthritis cohort. Semin Arthritis Rheum 2020; 50:915-922. [PMID: 32911288 DOI: 10.1016/j.semarthrit.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Time to discontinuation of biologic therapy may be related to mechanism of action. We aimed to compare discontinuation of tumor necrosis factor inhibitors (TNFi) versus non-TNFi in an observational rheumatoid arthritis cohort. METHODS Patients enrolled in the Ontario Best Practices Research Initiative (OBRI) starting biologic agents on or after 1st January 2010 were included. Time to discontinuation due to (1) any reason, (2) any of lack/loss of response, adverse events (AEs), physician, or patient decision, (3) lack/loss of response, and (4) AEs were assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. RESULTS A total of 932 patients were included of whom 174 (18.7%) received non-TNFi and 758 (81.3%) received TNFi. Over a median follow-up of 1.7 years, discontinuation was reported for 416 (44.6%) due to any reason, 367 (39.4%) due to any of lack/loss of response, AEs, physician, or patient decision, 192 (20.6%) due to lack/loss of response, and 102 (10.9%) due to AEs. After adjusting for propensity score, there was no significant difference in discontinuation between the two classes due to any reason [HR 1.14 (0.90-1.46), p = 0.28], lack/loss of response [HR: 1.01 (0.70-1.47), p = 0.95], and AEs [HR: 1.06 (0.64-1.73), p = 0.83]. Similar results were found in biologic naïve patients. CONCLUSIONS This analysis demonstrates that discontinuation of therapy is similar in patients started on TNFi and non-TNFi therapies. There was also no significant difference in stopping due to lack/loss of response or AEs, suggesting that these reasons should not drive the selection of one treatment over another.
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Affiliation(s)
- Mohammad Movahedi
- Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
| | - Elliot Hepworth
- Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Reza Mirza
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Cesta
- Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Maggie Larche
- Divisions of Rheumatology and Clinical Immunology and Allergy, Departments of Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Claire Bombardier
- Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine (DOM) and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.
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13
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Gudelj Gračanin A, Marković I, Golob M, Lucijanić M, Valetić AM, Morović-Vergles J. The effect of smoking on disease activity in rheumatoid arthritis - our experience. Acta Clin Croat 2020; 59:312-317. [PMID: 33456119 PMCID: PMC7808239 DOI: 10.20471/acc.2020.59.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate the association of smoking with disease activity, seropositivity, age and gender in patients with rheumatoid arthritis. We included 89 rheumatoid arthritis patients. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism rheumatoid arthritis classification criteria. Activity of the disease was measured by Disease Activity Score 28-joint count C-reactive protein (DAS28CRP). The subjects were stratified into smoking and non-smoking groups and cross-sectionally analyzed. There were 24 (27%) smokers and 65 (73%) nonsmokers. The mean age of patients was 57.1±8.8 years. The mean DAS28CRP was 5.81 in the smoking group and 5.57 in the non-smoking group, without statistically significant difference between the two groups (p=0.148). Similarly, smokers did not differ significantly from non-smokers according to age (p=0.443), gender (p=0.274), rheumatoid factor positivity (p=0.231), anti-citrullinated protein antibody positivity (p=0.754) or seropositivity (p=0.163). In this study, we found no association between smoking status and disease activity, seropositivity, age or gender in rheumatoid arthritis patients. Furthermore, disease activity was not related to age, gender or seropositivity. Additional studies on the effects of smoking on rheumatoid arthritis activity are needed.
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Affiliation(s)
- Ana Gudelj Gračanin
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Marković
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Majda Golob
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marko Lucijanić
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Marija Valetić
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Jadranka Morović-Vergles
- 1Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia; 2Division of Hematology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Zagreb, Croatia; 3Division of Clinical Immunology, Pulmonology and Rheumatology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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14
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Desai RJ, Dejene S, Jin Y, Liu J, Kim SC. Comparative Risk of Diabetes Mellitus in Patients With Rheumatoid Arthritis Treated With Biologic or Targeted Synthetic Disease-Modifying Drugs: A Cohort Study. ACR Open Rheumatol 2020; 2:222-231. [PMID: 32267094 PMCID: PMC7164631 DOI: 10.1002/acr2.11124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/12/2020] [Indexed: 12/22/2022] Open
Abstract
Objective The objective of this study is to compare the risk of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) treated with biologic or targeted synthetic disease‐modifying antirheumatic drugs. Methods A new‐user observational cohort study was conducted using data from a US commercial (Truven MarketScan, 2005‐2016) claims database and a public insurance (Medicare, 2010‐2014) claims database. Patients with RA who did not have DM were selected into one of eight exposure groups (abatacept, infliximab, adalimumab, golimumab, certolizumab, etanercept, tocilizumab, or tofacitinib) and observed for the outcome of incident DM, defined as a combination of a diagnosis code and initiation of a hypoglycemic treatment. A stabilized inverse probability–weighted Cox proportional hazards model was used to account for 56 confounding variables and estimate hazard ratios (HRs) and 95% confidence intervals (CIs). All analyses were conducted separately in two databases, and estimates were combined using inverse variance meta‐analysis. Results Among a total of 50 505 patients with RA from Truven and 17 251 patients with RA from Medicare, incidence rates (95% CI) for DM were 6.8 (6.1‐7.6) and 6.6 (5.4‐7.9) per 1000 person‐years, respectively. After confounding adjustment, the pooled HRs (95% CI) indicated a significantly higher risk of DM among adalimumab (2.00 [1.11‐3.03]) and infliximab initiators (2.34 [1.38‐3.98]) compared with abatacept initiators. The pooled HR (95% CI) for the etanercept versus abatacept comparison was elevated but not statistically significant (1.65 [0.91‐2.98]). The effect estimates for certolizumab, golimumab, tocilizumab, and tofacitinib, compared with abatacept, were highly imprecise because of a limited sample size. Conclusion Initiation of abatacept was associated with a lower risk of incident DM in patients with RA compared with infliximab or adalimumab.
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Affiliation(s)
- Rishi J Desai
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara Dejene
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yinzhu Jin
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jun Liu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Seoyoung C Kim
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Karpes Matusevich AR, Suarez‐Almazor ME, Cantor SB, Lal LS, Swint JM, Lopez‐Olivo MA. Systematic Review of Economic Evaluations of Cycling Versus Swapping Medications in Patients With Rheumatoid Arthritis After Failure to Respond to Tumor Necrosis Factor Inhibitors. Arthritis Care Res (Hoboken) 2020; 72:343-352. [DOI: 10.1002/acr.23859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 02/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Aliza R. Karpes Matusevich
- University of Texas MD Anderson Cancer Center and Houston School of Public HealthUniversity of Texas Health Science Center at Houston
| | | | | | - Lincy S. Lal
- School of Public HealthUniversity of Texas Health Science Center at Houston
| | - J. Michael Swint
- School of Public Health and McGovern School of MedicineUniversity of Texas Health Science Center at Houston
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16
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Perry M, Abdullah A, Frleta M, MacDonald J, McGucken A. The potential value of blood monitoring of biologic drugs used in the treatment of rheumatoid arthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20904850. [PMID: 32095163 PMCID: PMC7011331 DOI: 10.1177/1759720x20904850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022] Open
Abstract
The advent of biological therapies has been a major therapeutic advance in rheumatology. Many patients now enjoy improved quality of life through better disease control. The number of therapies continues to grow both within drug class (including biosimilar drugs) and via new mechanisms. For the first time, nonbiological drugs such as small-molecule inhibitors (Janus kinase inhibitors) have shown clinical equivalence. However, clinical unmet need remains with up to a third of patients commenced on a biologic therapy having minimal or no response: (a) Generally, the first biologic used secures the best response, with likelihood of remission falling thereafter with successive therapies; (b) the success of strategy trials using biological therapies can be difficult to replicate in clinical practice due to a combination of patient factors and service limitations. Accordingly, ensuring optimization of initial treatment is an important consideration before switching to alternatives. Therapeutic drug monitoring (TDM) is the measurement of serum levels of a biologic drug with the aim of improving patient care. It is usually combined with detection of any antidrug antibodies that could neutralize the effect of the therapy. This technology has the potential to be a form of 'personalized medicine' by individualizing therapy, in particular, dosing and likelihood of sustained treatment response. It requires a clear relationship between drug dose, blood concentration and therapeutic effect. This paper will outline the technology behind TDM and unpack what we can learn from our colleagues in gastroenterology, where the adoption of TDM is at a more advanced stage than in rheumatology. It will explore and set out a number of clinical scenarios where rheumatologists might find TDM helpful in day-to-day practice. Finally, an outline is given of international developments, including regulatory body appraisals and guideline development.
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Affiliation(s)
- Martin Perry
- Department Rheumatology, Royal Alexandra
Hospital, 9 Corsebar Road, Paisley Renfrewshire PA2 9PN, UK
| | - Azhar Abdullah
- Department Rheumatology, Royal Alexandra
Hospital, Paisley, UK
| | - Marina Frleta
- Department Rheumatology, Royal Alexandra
Hospital, Paisley, UK
| | - Jonathan MacDonald
- Department Gastroenterology, Queen Elizabeth
University Hospital, Glasgow, UK
| | - Andrew McGucken
- Department Rheumatology, Royal Alexandra
Hospital, Paisley, UK
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17
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Lauper K, Mongin D, Iannone F, Kristianslund EK, Kvien TK, Nordström DC, Pavelka K, Pombo-Suarez M, Rotar Z, Santos MJ, Codreanu C, Lukina G, Gale SL, John M, Luder Y, Courvoisier DS, Gabay C. Comparative effectiveness of TNF inhibitors and tocilizumab with and without conventional synthetic disease-modifying antirheumatic drugs in a pan-European observational cohort of bio-naïve patients with rheumatoid arthritis. Semin Arthritis Rheum 2020; 50:17-24. [DOI: 10.1016/j.semarthrit.2019.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 01/31/2023]
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18
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Chen C, Hartzema AG, Xiao H, Wei YJ, Chaudhry N, Ewelukwa O, Glover SC, Zimmermann EM. Real-world Pattern of Biologic Use in Patients With Inflammatory Bowel Disease: Treatment Persistence, Switching, and Importance of Concurrent Immunosuppressive Therapy. Inflamm Bowel Dis 2019; 25:1417-1427. [PMID: 30839057 DOI: 10.1093/ibd/izz001] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Medication persistence, defined as the time from drug initiation to discontinuation of therapy, has been suggested as a proxy for real-world therapeutic benefit and safety. This study seeks to compare the persistence of biologic drugs among patients with inflammatory bowel disease (IBD). METHODS Patients with newly diagnosed IBD were included in a retrospective study using Truven MarketScan database. Treatment persistence and switching was compared among biologic medications including infliximab, adalimumab, certolizumab, golimumab, and vedolizumab. Predictors for discontinuation and switching were evaluated using time-dependent proportional hazard regression. RESULTS In total, 5612 patients with Crohn's disease (CD) and 3533 patients with ulcerative colitis (UC) were included in this analysis. Less than half of the patients continued using their initial biologic treatment after 1 year (48.48% in CD cohort; 44.78% in UC cohort). In the first year, adalimumab had the highest persistence and lowest switching rates for both CD (median survival time: 1.04 years) and UC (median survival time: 0.84 years). In subsequent years, infliximab users were more likely to persist in the use of biologic. Combination therapy with immunomodulators significantly decreased the risk of discontinuation, especially when immunomodulator therapy was started more than 30 days before the biologic (hazard ratio [HR], 0.22; CI, 0.16, 0.32). The major predictors for noncompliance included infection and hospitalization. CONCLUSION Overall, the persistence profiles of biologics suggest a high rate of dissatisfaction or adverse disease outcomes resulting in discontinuation and switching to a different agent. Early initiation of immunomodulators will substantially increase the persistence of biologic treatment.
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Affiliation(s)
- Chao Chen
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Abraham G Hartzema
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Hong Xiao
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Yu-Jung Wei
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Naueen Chaudhry
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Ofor Ewelukwa
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Sarah C Glover
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Ellen M Zimmermann
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
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Keystone EC, Rampakakis E, Movahedi M, Cesta A, Stutz M, Sampalis JS, Nantel F, Maslova K, Bombardier C. Toward Defining Primary and Secondary Nonresponse in Rheumatoid Arthritis Patients Treated with Anti-TNF: Results from the BioTRAC and OBRI Registries. J Rheumatol 2019; 47:510-517. [PMID: 31263067 DOI: 10.3899/jrheum.190102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although most patients with rheumatoid arthritis (RA) respond to anti-tumor necrosis factor (anti-TNF) treatment, some present with initial nonresponse (1ry nonresponse) or lose initial responsiveness (2ry nonresponse). We compared the rate of real-world "nonresponse" to first anti-TNF as reported by treating physicians to the nonresponse rate per accepted definitions and recommended treat-to-target strategies. METHODS Patients were included from the Biologic Treatment Registry Across Canada (BioTRAC) and Ontario Best Practices Research Initiative (OBRI) registries who were taking their first anti-TNF, with ≥ 1 followup visit. Posthoc reclassification of physician-reported nonresponse was based on prior achievement of 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) low disease activity (LDA), Clinical Disease Activity Index (CDAI) LDA, or good/moderate European League Against Rheumatism (EULAR) response, and actual time of physician-reported nonresponse. RESULTS Among 736 BioTRAC and 640 OBRI patients, 13.7% and 18%, respectively, discontinued their anti-TNF because of physician-reported nonresponse. Based on reclassification using disease activity, 65.6% (BioTRAC) and 87.2% (OBRI) of 1ry nonresponders did not achieve DAS28-ESR LDA, 65.6%/90.7% CDAI LDA, and 46.9%/61.5% good/moderate EULAR response. Among 2ry nonresponders, 50.7%/47.8% did not achieve DAS28-ESR LDA, 37.7%/52.9% CDAI LDA, and 15.9%/19.6% good/moderate EULAR response before treatment discontinuation. Regarding actual time of nonresponse, 18.8% of BioTRAC and 60.8% of OBRI 1ry nonresponders discontinued at ≤ 6 months. In both registries, a high proportion of 2ry nonresponders discontinued their anti-TNF after 12 months (87.0% BioTRAC, 60.9% OBRI). CONCLUSION Physician-reported 1ry nonresponse was more correlated with non-achievement of DAS28-ESR LDA or CDAI LDA, whereas 2ry nonresponse with actual time of discontinuation. Further work is needed to confirm the importance of response and type of response to the initial anti-TNF in identifying patients most likely to benefit from a second biologic agent treatment.
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Affiliation(s)
- Edward C Keystone
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada. .,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology.
| | - Emmanouil Rampakakis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Mohammad Movahedi
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Angela Cesta
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Melissa Stutz
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - John S Sampalis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Francois Nantel
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Karina Maslova
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Claire Bombardier
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
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20
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Lauper K, Mongin D, Alpizar-Rodriguez D, Codreanu C, Iannone F, Kristianslund EK, Kvien TK, Pavelka K, Pombo-Suarez M, Santos MJ, Gabay C, Finckh A, Courvoisier DS. Drug retention of biological DMARD in rheumatoid arthritis patients: the role of baseline characteristics and disease evolution. Rheumatology (Oxford) 2019; 58:2221-2229. [DOI: 10.1093/rheumatology/kez221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To examine the association of the evolution in physician-reported and patient-reported outcomes with decision to stop biological DMARDs (bDMARDs) in RA. The contribution of baseline characteristics is well established, but little is known about how the disease evolution influences the decision to discontinue therapy.
Methods
RA patients who initiated a bDMARD treatment from 2009 and with information on date of visit were pooled from seven European RA registers. Each outcome was divided into baseline assessments (capturing the inter-individual differences at drug initiation) and changes from baseline at subsequent visits (capturing the individual evolution). Cox regression models were used to examine their association with drug discontinuation, adjusting for baseline patient and co-therapy characteristics and stratifying by register and calendar year of drug initiation.
Results
A total of 25 077 patients initiated a bDMARDs (18 507 a TNF-inhibitor, 3863 tocilizumab and 2707 abatacept) contributing an amount of 46 456.8 patient-years. Overall, drug discontinuation was most strongly associated with a poor evolution of the DAS28, with a hazard ratio of 1.34 (95% CI 1.29, 1.40), followed by its baseline value. A change of Physician Global Assessment was the next strongest predictor of discontinuation, then the Patient Global Assessment.
Conclusions
The decision to discontinue treatments appears to be mostly influenced by DAS28 and particularly its evolution over time, followed by Physician Global Assessment evolution, suggesting that the decision to stop bDMARDs relies more on the physician’s than on the patient’s global assessment.
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Affiliation(s)
- Kim Lauper
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
| | - Denis Mongin
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
| | | | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania, Italy
| | | | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karel Pavelka
- Institute of Rheumatology, Prague and Clinic of Rheumatology, Charles University, Prague, Czech Republic
| | - Manuel Pombo-Suarez
- Rheumatology Unit, Clinical University Hospital, University of Santiago de Compostela, Santiago, Spain
| | - Maria J Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, on behalf of Reuma.pt
| | - Cem Gabay
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, University Hospitals Geneva, Geneva, Switzerland
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21
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Fournier M, Chen CI, Kuznik A, Proudfoot C, Mallya UG, Michaud K. Sarilumab monotherapy compared with adalimumab monotherapy for the treatment of moderately to severely active rheumatoid arthritis: an analysis of incremental cost per effectively treated patient. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:117-128. [PMID: 30787625 PMCID: PMC6368117 DOI: 10.2147/ceor.s183076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Treatment outcomes and direct medical costs were examined, from a US health payer perspective, of monotherapy with sarilumab 200 mg subcutaneous (SC) every 2 weeks (Q2W) vs adalimumab 40 mg SC Q2W/QW in adult patients with moderately to severely active rheumatoid arthritis who are intolerant of, inadequate responders to, or considered inappropriate candidates for continued methotrexate treatment. Patients and methods Short-term analysis was based on 24-week wholesale acquisition costs of drugs and treatment response observed in the MONARCH Phase III trial (NCT02332590) per American College of Rheumatology (ACR) 20/50 criteria and European League Against Rheumatism (EULAR) Moderate/Good Disease Activity Score 28-joint count erythrocyte sedimentation rate. Long-term analysis, which also considered drug administration and routine care costs, was conducted via a 6-month decision tree and a 1- to 10-year Markov model with microsimulation of patient profiles from the MOBILITY Phase III trial (NCT01061736). Utilities and quality-adjusted life-years (QALYs) were estimated by mapping 6-month ACR levels to a relative change in Health Assessment Questionnaire – Disability Index score and via published algorithms. Results For sarilumab and adalimumab, respectively, 24-week drug costs were $18,954 and $29,232, and costs per responder were $26,435 vs $50,055 on ACR20; $41,475 vs $98,425 on ACR50; and $22,511 vs $41,230 on EULAR Moderate/Good. Base case results at 10 years for total costs and QALYs were $176,977 and 2.75 for sarilumab and $212,136 and 2.61 for adalimumab, respectively. Sarilumab was consistently the more effective and cost-saving treatment across all short-term and long-term incremental analyses. Conclusion Sarilumab monotherapy was the economically dominant treatment on incremental cost per responder and incremental cost per QALY compared with adalimumab monotherapy. These results were maintained within the sensitivity analyses.
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Affiliation(s)
- Marie Fournier
- Health Economics & Value Assessment, Sanofi France, Chilly-Mazarin, France,
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA.,The National Databank for Rheumatic Diseases, Wichita, KS, USA
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22
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Mangoni AA, Al Okaily F, Almoallim H, Al Rashidi S, Mohammed RHA, Barbary A. Relapse rates after elective discontinuation of anti-TNF therapy in rheumatoid arthritis: a meta-analysis and review of literature. BMC Rheumatol 2019; 3:10. [PMID: 30886998 PMCID: PMC6408847 DOI: 10.1186/s41927-019-0058-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission. METHODS Systematic searches of PubMed/MEDLINE, Cochrane Library databases, grey literature (unpublished and ongoing trials) from the WHO International Clinical Trials Registry Platform and the US National Institutes of Health were performed for studies reporting the outcomes of elective discontinuation of TNF-α inhibitor in RA patients after remission. Random-effects models for meta-analyses were conducted on extracted data. RESULTS Out of 390 references screened, 16 RCTs were included. Meta-analysis of 1264 patient data revealed a relapse rate of 0.47 (95% CI 0.41-0.54). Sensitivity analysis showed that none of the studies had higher influence on the results. CONCLUSIONS Almost half of all the RA patients in remission relapse after elective TNF-α inhibitor discontinuation. This information might be useful when considering this management option with individual patients.
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Affiliation(s)
- Arduino A Mangoni
- 1Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Bedford Park, SA 5042 Australia
| | | | - Hani Almoallim
- 3Department of Medicine, Umm Alqura University, Jeddah, Kingdom of Saudi Arabia
| | | | - Reem Hamdy A Mohammed
- 4Rheumatology and Clinical Immunology, Department of Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt
- 5Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Amal Barbary
- 6Department of Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Elgesh Street, Tanta, Gharbeia Egypt
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Acar M, Juneja P, Handel M. Treatment persistence of subcutaneous TNF inhibitors among Australian patients with immune-mediated rheumatic disease (IMRD). Open Access Rheumatol 2018; 10:151-160. [PMID: 30568519 PMCID: PMC6267492 DOI: 10.2147/oarrr.s179704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction To describe the persistence of treatment with subcutaneous tumor necrosis factor inhibitors (TNFi) adalimumab, etanercept, and golimumab in immune-mediated rheumatic disease (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) by treatment sequence (first-line treatment, second-line or further lines of treatment). Methods A retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme 10% sample data from January 1, 2010, to June 30, 2016. Pharmaceutical Benefits Scheme indications were used to identify patient prescriptions for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A patient was considered persistent until a 3-month gap period where a prescription was not dispensed. The 3-month gap interval was chosen because only 1% of all discontinuations occurred beyond this 3-month period. Results Data from 2,612 first-line patients were included. Treatment discontinuation among first-line patients treated with etanercept or adalimumab was not significantly different from those treated with golimumab (HR 1.10, 95% CI 0.95–1.28, P=0.22; HR 1.06, 95% CI 0.93–1.22, P=0.39; respectively). Among the 1,276 patients in the second-line cohort (etanercept=41%, adalimumab=41%, golimumab=18%) discontinuation was significantly higher for patients on etanercept compared with golimumab (HR 1.24, 95% CI 1.03–1.50, P=0.03); but not for adalimumab compared with golimumab (HR 1.11, 95% CI 0.91–1.34, P=0.31). In the third-line setting, treatment persistence with etanercept was longer than golimumab (HR 0.75, 95% CI 0.59–0.96, P=0.02), but there was no difference between golimumab and adalimumab. Similar findings occurred in the propensity score matched population. Conclusion Our study shows there is variance in real-world persistence to TNFi in patients with immune-mediated rheumatic disease by line of therapy, with the time on therapy decreasing by line. Australian persistence has been reported at lower overall rates than international evidence.
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Tonin FS, Steimbach LM, Leonart LP, Ferreira VL, Borba HH, Piazza T, Araújo AG, Fernandez-Llimos F, Pontarolo R, Wiens A. Discontinuation of non-anti-TNF drugs for rheumatoid arthritis in interventional versus observational studies: a systematic review and meta-analysis. Eur J Clin Pharmacol 2018; 74:1513-1521. [PMID: 30022333 DOI: 10.1007/s00228-018-2524-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/11/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Although randomized controlled trials (RCTs) are the gold standard for the assessment of clinical outcomes, long-term extension trials (LTEs) and observational cohorts may help generate evidence. Our goal was to compare the discontinuation rates of abatacept, rituximab, and tocilizumab in rheumatoid arthritis (RA) reported in different study designs. METHODS A systematic review was conducted with searches in PubMed, Scopus, and the Cochrane Library, plus a manual search, for RCTs, LTEs, and observational cohorts reporting discontinuation rates by any of three causes (all-cause, inefficacy, adverse events). Meta-analyses with sensitivity analyses and meta-regressions were conducted. RESULTS Of the 111 studies included, 74 were RCTs (n = 55) or LTEs (n = 17) reporting data on abatacept (n = 33), rituximab (n = 10), and tocilizumab (n = 31) and 37 were observational cohort studies (abatacept = 11, rituximab = 8, tocilizumab = 18). The follow-up duration did not differ among the study designs. Discontinuation rates were similar among the drugs but varied among the study designs. Discontinuation rates were significantly higher in cohort studies than those in interventional studies for the three drugs. Sensitivity analyses could not identify patient characteristics associated with these differences. Meta-regression analyses demonstrated no correlation between study follow-up duration and discontinuation rates. CONCLUSIONS The discontinuation rates reported for non-anti-TNF drugs varied relative to the study design in which they were investigated. Regulatory agencies, price-setting entities, and evidence-gathering researchers should consider the effect of the real-life environment in their decisions and conclusions.
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Affiliation(s)
| | | | | | | | - Helena H Borba
- Department of Pharmacy, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Curitiba, Paraná, Brazil
| | - Thais Piazza
- Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Curitiba, Paraná, Brazil
| | - Astrid Wiens
- Department of Pharmacy, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Curitiba, Paraná, Brazil.
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25
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Strand V, Tundia N, Song Y, Macaulay D, Fuldeore M. Economic Burden of Patients with Inadequate Response to Targeted Immunomodulators for Rheumatoid Arthritis. J Manag Care Spec Pharm 2018; 24:344-352. [PMID: 29578852 PMCID: PMC10397636 DOI: 10.18553/jmcp.2018.24.4.344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Targeted immunomodulators (TIMs), including biologic disease-modifying antirheumatic drugs (DMARDs) and JAK/STAT inhibitors, are effective therapies for rheumatoid arthritis (RA), but some patients fail to respond or lose response over time. This study estimated the real-world prevalence of RA patients with inadequate responses to an initial TIM (nonresponders) in the United States and assessed their direct and indirect economic burden compared with treatment responders. METHODS Administrative claims data (January 1999-March 2014) from a large private-insurer database were used, which included work-loss data from a subset of reporting companies. Eligible patients (classified as responders and nonresponders) had ≥ 1 claim for a TIM approved for the treatment of RA and ≥ 2 RA diagnoses in the claims history, with continuous pharmaceutical and medical benefit eligibility for 6 months before (baseline) and 12 months after (study period) the date of the first TIM claim (index date). All-cause and RA-related health care resource use (HCRU) and costs, work loss, and indirect costs during the study period were compared for responders versus nonresponders. Multivariable regression was used to adjust for baseline covariates. Sensitivity analyses of HCRU and direct costs were conducted for patients with index dates before and after 2008 to account for different approval dates of TIMs. RESULTS Of 7,540 eligible patients with RA, 2,527 (34%) were classified as responders, and 5,013 (66%) were classified as nonresponders; 407 and 723 had work-loss data, respectively. After adjusting for baseline covariates, nonresponders had significantly higher HCRU, including inpatient admissions (incidence rate ratio [IRR] = 1.94), outpatient visits (IRR = 1.19), emergency department visits (IRR = 1.53), and number of prescription fills (IRR = 1.09; all, P < 0.001). Nonresponders also had significantly higher adjusted all-cause ($12,868 vs. $9,621, respectively) and RA-related ($5,740 vs. $4,495; both, P < 0.001) medical costs compared with responders. In addition, nonresponders reported significantly more days of work lost compared with responders (22.1 vs. 16.7 days, respectively; IRR = 1.21; P = 0.007) and higher indirect costs ($3,548 vs. $2,890; P = 0.002). Sensitivity analyses of HCRU and direct costs by index date (before and after 2008) were consistent with the full sample. CONCLUSIONS A large portion of patients with RA had inadequate responses to their initial TIM therapy with significantly higher economic burden, including higher HCRU, medical costs, and indirect costs due to work loss, compared with TIM therapy responders. DISCLOSURES Funding for this research was provided by AbbVie, which was involved in all stages of the study research and manuscript preparation. Tundia and Fuldeore are employed by AbbVie. Song and Macaulay are employed by Analysis Group, which received grants from AbbVie to conduct this study. Strand reports grants and personal fees from AbbVie, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Corrona, Crescendo, Genentech/Roche, GSK, Janssen, Lilly, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, and UCB outside the submitted work. Study concept and design were contributed by Tundia, Song, and Macaulay, along with other authors. Data analyses were designed and conducted by Song and Macaulay. All authors contributed to data interpretation. Writing of the manuscript was led by Tundia, Song, and Macaulay, with revisions by all authors. A synopsis of the current research was presented at the American College of Rheumatology/Association of Rheumatology Health Professionals meeting, which took place in Washington, DC, during November 11-16, 2016.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California
| | | | - Yan Song
- Analysis Group, Boston, Massachusetts
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Vittecoq O, Richard L, Banse C, Lequerré T. The impact of smoking on rheumatoid arthritis outcomes. Joint Bone Spine 2017; 85:135-138. [PMID: 29246527 DOI: 10.1016/j.jbspin.2017.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Olivier Vittecoq
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France.
| | - Laetitia Richard
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France
| | - Christopher Banse
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France
| | - Thierry Lequerré
- Service de rhumatologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Université de Rouen, 76000 Rouen, France
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Wells AF, Curtis JR, Betts KA, Douglas K, Du EX, Ganguli A. Systematic Literature Review and Meta-analysis of Tumor Necrosis Factor–Alpha Experienced Rheumatoid Arthritis. Clin Ther 2017; 39:1680-1694.e2. [DOI: 10.1016/j.clinthera.2017.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/28/2017] [Indexed: 12/29/2022]
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Grabner M, Boytsov NN, Huang Q, Zhang X, Yan T, Curtis JR. Costs associated with failure to respond to treatment among patients with rheumatoid arthritis initiating TNFi therapy: a retrospective claims analysis. Arthritis Res Ther 2017; 19:92. [PMID: 28506320 PMCID: PMC5433023 DOI: 10.1186/s13075-017-1293-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/07/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Tumor necrosis factor inhibitors (TNFi) are common second-line treatments for rheumatoid arthritis (RA). This study was designed to compare the real-world clinical and economic outcomes between patients with RA who responded to TNFi therapy and those who did not. METHODS For this retrospective cohort analysis we used medical and pharmacy claims from members of 14 large U.S. commercial health plans represented in the HealthCore Integrated Research Database. Adult patients (aged ≥18 years) diagnosed with RA and initiating TNFi therapy (index date) between 1 January 2007 and 30 April 2014 were included in the study. Treatment response was assessed using a previously developed and validated claims-based algorithm. Patients classified as treatment responders in the 12 months postindex were matched 1:1 to nonresponders on important baseline characteristics, including sex, age, index TNFi agent, and comorbidities. The matched cohorts were then compared on their all-cause and RA-related healthcare resource use, and costs were assessed from a payer perspective during the first, second, and third years postindex using parametric tests, regressions, and a nonparametric bootstrap. RESULTS A total of 7797 patients met the study inclusion criteria, among whom 2337 (30%) were classified as treatment responders. The responders had significantly lower all-cause hospitalizations, emergency department visits, and physical/occupational therapy visits than matched nonresponders during the first-year postindex. Mean total all-cause medical costs were $5737 higher for matched nonresponders, largely driven by outpatient visits and hospitalizations. Mean all-cause pharmacy costs (excluding costs of biologics) were $354 higher for matched nonresponders. Mean RA-related pharmacy costs (conventional synthetic and biologic drugs), however, were $8579 higher in the responder cohort, driven by higher adherence to their index TNFi agent (p < 0.01 for all comparisons). A similar pattern of cost differentiation was observed over years 2 and 3 of follow-up. CONCLUSIONS In this real-world study we found that, compared with matched nonresponders, patients who responded to TNFi treatments had lower all-cause medical, pharmacy, and total costs (excluding biologics) up to 3 years from initiation of TNFi therapy. These cost differences between the two cohorts provide a considerable offset to the cost of RA medications and should encourage close monitoring of treatment response to minimize disease progression with appropriate therapy choices.
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Affiliation(s)
- Michael Grabner
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE 19801 USA
| | | | - Qing Huang
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE 19801 USA
| | | | | | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
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Park SK, Park SH, Lee MY, Park JH, Jeong JH, Lee EK. Cost-effectiveness Analysis of Treatment Sequence Initiating With Etanercept Compared With Leflunomide in Rheumatoid Arthritis: Impact of Reduced Etanercept Cost With Patent Expiration in South Korea. Clin Ther 2016; 38:2430-2446.e3. [DOI: 10.1016/j.clinthera.2016.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/03/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022]
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Zhang L, Wang T, Li Q, Huang J, Xu H, Li J, Wang Y, Liang Q. Fabrication of novel vesicles of triptolide for antirheumatoid activity with reduced toxicity in vitro and in vivo. Int J Nanomedicine 2016; 11:2663-73. [PMID: 27354796 PMCID: PMC4907735 DOI: 10.2147/ijn.s104593] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Triptolide (TP) displays a strong immunosuppression function in immune-mediated diseases, especially in the treatment of rheumatoid arthritis. However, in addition to its medical and health-related functions, TP also exhibits diverse pharmacological side effects, for instance, liver and kidney toxicity and myelosuppression. In order to reduce the side effects, a nano drug carrier system (γ-PGA-l-PAE-TP [PPT]), in which TP was loaded by a poly-γ-glutamic acid-grafted l-phenylalanine ethylester copolymer, was developed. PPT was characterized by photon scattering correlation spectroscopy and transmission electron microscopy, which demonstrated that the average diameter of the drug carrier system is 98±15 nm, the polydispersity index is 0.18, the zeta potential is −35 mV, and the TP encapsulation efficiency is 48.6% with a controlled release manner. The methylthiazolyldiphenyl-tetrazolium bromide assay and flow cytometry revealed that PPT could decrease toxicity and apoptosis induced by free TP on RAW264.7 cells, respectively. The detection of reactive oxygen species showed that PPT could decrease the cellular reactive oxygen species induced by TP. Compared with the free TP-treated group, PPT improved the survival rate of the mice (P<0.01) and had no side effects or toxic effects on the thymus index (P>0.05) and spleen index (P>0.05). The blood biochemical indexes revealed that PPT did not cause much damage to the kidney (blood urea nitrogen and creatinine), liver (serum alanine aminotransferase and aspartate aminotransferase), or blood cells (P>0.05). Meanwhile, hematoxylin and eosin staining and terminal-deoxynucleotidyl transferase dUTP nick-end labeling staining indicated that PPT reduced the damage of free TP on the liver, kidney, and spleen. Our results demonstrated that PPT reduced free TP toxicity in vitro and in vivo and that it is a promising fundamental drug delivery system for rheumatoid arthritis treatment.
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Affiliation(s)
- Li Zhang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Tengteng Wang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jing Huang
- Biochemistry and Molecular Biology, School of Life Science, East China Normal University, Shanghai, People's Republic of China
| | - Hao Xu
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jinlong Li
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yongjun Wang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Qianqian Liang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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Mahlich J, Sruamsiri R. Persistence with biologic agents for the treatment of rheumatoid arthritis in Japan. Patient Prefer Adherence 2016; 10:1509-19. [PMID: 27540283 PMCID: PMC4981174 DOI: 10.2147/ppa.s110147] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To assess persistence rates of biologic agents for the treatment of rheumatoid arthritis in Japan. METHODS Based on Japanese claims data of 16,214 patients between 2012 and 2014, 6-, 12-, and 18-month persistence rates of different biologic agents were calculated. Determinants of persistence were assessed by means of a multivariate Cox proportional hazard model controlling for age, sex, and comorbidities. A sensitivity analysis was performed with different definitions of persistence and parametric survival analysis. RESULTS Overall persistence rates in Japan are high and reach 86% after 1 year in the entire sample. The persistence rate for the biologic-naïve subpopulation is above 95%. Persistence is higher for older patients (hazard ratio 0.60 [95% confidence interval 0.40-0.91] for >75 years compared to ≤60 years) and lower for patients with a high comorbidity score (hazard ratio 1.33; 95% confidence interval 1.03-1.70 for Charlson Comorbidity Index score 3-5 compared to ≤2). We found a high variation of persistence between different drugs. CONCLUSION Japanese rheumatoid arthritis patients have a high persistence rate of biologic treatments. However, multiple factors affect the persistence rate of Japanese patients, including age, comorbidities, and patient type. Naïve patients tend to have a higher persistence rate than continuing biologic patients.
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Affiliation(s)
- Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
- Correspondence: Jörg Mahlich, Health Economics, Janssen Pharmaceutical KK, 5-2, Nishi-kanda 3-chome Chiyoda-ku, Tokyo, 101-0065, Japan, Tel +81 3 4411 5666, Fax +81 3 4411 5050, Email
| | - Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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