Impact of Biologic Agents With and Without Concomitant Methotrexate and at Reduced Doses in Older Rheumatoid Arthritis Patients

Abstract

Background This study examines whether concomitant methotrexate (MTX) use is associated with better biologic persistence and whether self-administered anti-TNF therapies are used at reduced doses in real-world clinical care settings, not just clinical trials. Methods We conducted a retrospective cohort study among RA patients using Medicare claims data from 2006 to 2012. Subjects were new initiators of etanercept, infliximab, adalimumab, abatacept and tocilizumab with at least 12 months of continuous medical and pharmacy coverage after treatment initiation. We examined the association between concomitant MTX use and persistence on biologics using Cox proportional hazard regression adjusting for demographics and baseline co-morbidities. We further identified a subgroup of patients who initiated and were adherent on etanercept or adalimumab for at least 12 months and examined the proportion of patients who subsequently used these therapies at reduced doses continuously for an additional 12, 18, and 24 months. Results Of 26,510 eligible RA patients, 10,511 initiated biologic monotherapy. Overall, patients initiated biologic monotherapy were 1.4 (95% CI, 1.3–1.5) times more likely to discontinue at 1-year and 1.8 (95% CI, 1.7–2.0) times more likely if starting infliximab monotherapy. Approximately 10–20% of patients who initiated and adhered to etanercept and adalimumab for ≥ 12 months subsequently used reduced-dose therapy for an 12 additional months and beyond. Conclusion In real-world practice, concomitant MTX was associated with improved persistence on biologic therapy, especially for infliximab users; reduced-dose injectable anti-TNF therapy was used by a substantial proportion of RA patients.

Long-term drug survival and predictor analysis of the whole psoriatic patient population on biological therapy in Hungary

“…On the other hand, there are studies which similar to the current study did not find previous biological therapy usage as a negative predictor of persistence (11,16,20,21,23). Although concomitant MTX usage has been shown to be associated with a better persistence of biologicals in rheumatological settings, there is no conclusive evidence in psoriasis about additional MTX as a positive predictor (24,25). In a systematic review, Bezooijen et al selected eight studies, which generally showed that combination therapy of biologicals and MTX had higher efficacy than biological monotherapy, which could also indicate a positive effect of MTX on the drug survival; however, persistence was not investigated in this study (26).…”

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

“…This pivotal drug works in synergy with biologic agents, increasing their efficacy, and older patients receiving combination therapy (methotrexate and anti-TNF) have higher persistence than those on biologics monotherapy, with the strongest associations being observed for infliximab and adalimumab [41].…”

“…Other confounding factors that could be monitored to prove biological safety and efficacy of biologics in this particular population are largely 13 missing (such as steroid decrease). Drug adherence is significantly higher in older patients concomitantly taking methotrexate [41,46].…”

Methotrexate in Rheumatoid Arthritis – 2015: New Facts and Ideas

“…В ретроспективное исследование J. Zhang и соавт. [74] было включено 26 510 пациентов пожилого возраста с РА, наблюдавшихся в рамках программы Medicare (феде-ральная программа медицинского страхования для населе-ния старше 65 лет). Авторы исследовали связь между при-емом МТ и длительностью приема ГИБП, включая ЭТЦ, ИНФ, АДА, абатацепт (АБЦ) и ТЦЗ.…”