Adherence and dosing interval of subcutaneous antitumour necrosis factor biologics among patients with inflammatory arthritis: analysis from a Canadian administrative database

Abstract

ObjectivesSubcutaneous tumour necrosis factor alpha TNFαinhibitors (SC-TNFis) such as golimumab (GLM), adalimumab (ADA), etanercept (ETA) and certolizumab pegol (CZP) have been used for many years for the treatment of inflammatory arthritis. Non-adherence to therapy is an important modifiable factor that may compromise patient outcomes. The aim of this analysis was to compare adherence and dosing interval of SC-TNFis in the treatment of people with inflammatory arthritis.DesignWe used the IMS Brogan database combining both Canadian private and public drug plan databases of Ontario and Quebec. Target drugs included SC-TNFis for inflammatory arthritis. The index period was from 1 January 2010 to 30 June 2012 and patients were followed for 24 months through 30 June 2014. Inclusion criteria were adult patients newly prescribed a SC-TNFis with at least three prescriptions and retained on therapy at 24 months.Dosing regimens as per the product monographs were used to compare actual versus expected drug utilisation. The mean possession ratio was used as a marker for adherence. Patients who scored >80% were considered adherent. The average days between units was estimated by taking the total days on therapy and divided by the number of units the patient received.Results4035 patients were included: 683 (16.9%), 1400 (34.7%), 1765 (43.7%) and 187 (4.6%) were treated with GLM, ADA, ETA and CZP, respectively. The proportion of adherent patients in the GLM cohort (n=595/683, 87%, p<0.0001) was greater compared with ADA (n=1044/1400, 75%), ETA (n=1285/1765, 73%) and CZP-treated patients (132/187, 71%). In addition, the number of patients receiving biological drug at a shorter dosing interval was similar between cohorts, and was 5%, 6%, 12% and 4% in GLM (≤26 days), ADA (≤12 days), ETA (≤6 days) and CZP-treated patients (≤12 days), respectively.ConclusionsIn this real-life administrative database, GLM had better adherence compared with other SC-TNFis.

<p>Real-World Observational Study on the Characteristics and Treatment Patterns of Allergic Asthma Patients Receiving Omalizumab in Canada</p>

“…These databases have been previously described. [29][30][31] The algorithm used for the current study was similar to one used in a previous study of severe eosinophilic asthma in primary care in Canada. 32 The study period is described in Figure 1.…”

Adherence to etanercept therapy in rheumatoid arthritis patients during 3 years of follow-up

“…during a serious infection or at time of surgery does not constitute non-adherence. Previous studies did not take this into account when assessing non-adherence in RA patients treated with bDMARDs [ 2 – 6 , 8 – 11 ]. Furthermore, there are several methods to detect adherence.…”

Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study

“…Various studies have examined adherence in a single rheumatoid condition, often RA,18–24 26–29 but we could only find a single Italian study measuring adherence across RA, AS and PsA,44 though applying a different method to our study. The challenge in comparing results between studies is often the absence of any detail on how adherence was measured and where specified, multiple measures being used.…”

“…Most of the direct comparisons for adherence and persistence are from observational studies, mainly focusing on the first biologic to reach the market/clinical practice (infliximab, adalimumab and etanercept) 17–19. A few studies have incorporated other biologics,20–26 with more biologics set to be approved in the upcoming years. Although the standardised measurement of adherence and persistence, dividing the process in three phases—initiation, implementation and discontinuation—has been advocated by Vrijens et al and endorsed by the European Society for Patient Adherence, Compliance and Persistence (ESPACOMP),27 this methodology has mainly been applied to oral medications and not to biologics, which are administered subcutaneously or intravenously, with complex dosing schedules.…”