Real-world evaluation of TNF-inhibitor utilization in rheumatoid arthritis

Harnett, James; Wiederkehr, Daniel; Gerber, Robert A.; Gruben, David; Koenig, Andrew; Bourret, J

doi:10.3111/13696998.2015.1099538

Cited by 32 publications

(31 citation statements)

References 49 publications

(47 reference statements)

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“…Switching rates in the study by Howe et al [13] ranged from 2.8% to 9.2% for ADA and 0% to 20% for IFX across these disease states [13]. Similar proportions of patients receiving ADA and IFX switched therapies during the first 12 months, which was comparable with the 15.4% rate of patients with RA switching that was observed in the study by Harnett et al [15]. A study of patients with UC by Rubin et al [16] showed similar rates of switching for ADA (10.5%) and IFX (9.4%) compared with our data; discontinuation rates were, however, lower at 0% and 13.3%, respectively, compared with data presented here.…”

Section: Discussionsupporting

confidence: 76%

Ulcerative Colitis Treatment Patterns and Cost of Care

Null

Pasquale

et al. 2017

Value in Health

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Objectives: To examine treatment patterns, dosing, health care resource utilization, and cost of tumor necrosis factor inhibitors (TNFi), adalimumab (ADA) and infliximab (IFX), among patients enrolled in US Humana insurance plans who have been diagnosed with ulcerative colitis (UC). Methods: This retrospective cohort study identified the first pharmacy or medical claim for ADA or IFX (from January 1, 2007, to December 31, 2014) in patients with continuous enrollment for 6 months or more preindex and 12 months or more postindex, with one or more UC diagnosis claim 6 months pre-or postindex. TNFi discontinuation was defined as a therapy gap of 56 days or more for ADA and 112 days or more for IFX. TNFi switch was defined as nonindex TNFi initiation. Health care resource utilization and costs were characterized quarterly according to treatment patterns. Results: The study population comprised 295 patients: mean age 50.9 years, 50.5% females, and 61.7% in southern United States. At the index date, 17% of patients received ADA and 83% received IFX. Treatment discontinuation was observed in 52% of ADA and 45% of IFX users through 12 months postindex (mean time 19 and 22 weeks, respectively). Among discontinuers, 46% of ADA and 68% of IFX users did not restart/switch TNFi. ADA and IFX showed mean times to switch of 18 and 30 weeks, respectively. TNFi discontinuers had the lowest mean quarterly total health care cost ($3,935) versus patients who initiated/switched TNFi ($15,004). Nevertheless, discontinuers had higher UC-related hospitalization versus patients receiving therapy.Conclusions: Approximately half of ADA and IFX users discontinued, with approximately half of discontinuers not restarting/switching therapies. Further investigation of treatment patterns and outcomes after TNFi discontinuation is required.

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Section: Discussionsupporting

confidence: 76%

Ulcerative Colitis Treatment Patterns and Cost of Care

Null

Pasquale

et al. 2017

Value in Health

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“…17 Several US studies using different methods estimated that 7.8% to 15.4% of patients switched to a second biologic DMARD within 1 year after initiating use of their first biologic DMARD. 18,[24][25][26][27] As the number of biologic DMARDs approved to treat RA increases, the selection of subsequent biologic DMARDs becomes increasingly challenging. 28 For instance, the 2013 EULAR guidelines recommend a second biologic DMARD be started if no improvement is observed within 3 months or the treatment goal is not achieved within 6 months after initiating use of the first biologic DMARD.…”

Section: Discussionmentioning

confidence: 99%

Real-world Effectiveness of Biologic Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis After Etanercept Discontinuation in the United Kingdom, France, and Germany

Betts

Messali

et al. 2017

Clinical Therapeutics

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“…Another real-world study recently examined treatment patterns among patients who initiated treatment with a TNFi in 2011 or 2012, including 764 patients who switched to a different targeted DMARD 7. The probability of switching again was significantly greater for TNFi cyclers compared with non-TNFi switchers (37% vs 28%; P =0.031).…”

Section: Discussionmentioning

confidence: 99%

Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

Bonafede¹,

Curtis²,

McMorrow³

et al. 2016

CEOR

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ObjectivesAfter treatment failure with a tumor necrosis factor inhibitor (TNFi), patients with rheumatoid arthritis (RA) can switch to another TNFi (TNFi cyclers) or to a targeted disease-modifying antirheumatic drug (DMARD) with a non-TNFi mechanism of action (non-TNFi switchers). This study compared treatment patterns and treatment effectiveness between TNFi cyclers and non-TNFi switchers in patients with RA.MethodsThe analysis included a cohort of patients from the Truven Health Analytics MarketScan Commercial database with RA who switched from a TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) either to another TNFi or to a non-TNFi targeted DMARD (abatacept, tocilizumab, or tofacitinib) between January 1, 2010 and September 30, 2014. A claims-based algorithm was used to estimate treatment effectiveness based on six criteria (adherence, no dose increase, no new conventional therapy, no switch to another targeted DMARD, no new/increased oral glucocorticoid, and intra-articular injections on <2 days).ResultsThe cohort included 5,020 TNFi cyclers and 1,925 non-TNFi switchers. Non-TNFi switchers were significantly less likely than TNFi cyclers to switch therapy again within 6 months (13.2% vs 19.5%; P<0.001) or within 12 months (29.7% vs 34.6%; P<0.001) and significantly more likely to be persistent on therapy at 12 months (61.8% vs 58.2%; P<0.001). Non-TNFi switchers were significantly more likely than TNFi cyclers to achieve all six of the claims-based effectiveness algorithm criteria for the 12 months after the initial switch (27% vs 24%; P=0.011).ConclusionAlthough the absolute differences were small, these results support switching to a non-TNFi targeted DMARD instead of TNFi cycling when patients with RA require another therapy after TNFi failure.

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Real-world evaluation of TNF-inhibitor utilization in rheumatoid arthritis

Cited by 32 publications

References 49 publications

Ulcerative Colitis Treatment Patterns and Cost of Care

Ulcerative Colitis Treatment Patterns and Cost of Care

Real-world Effectiveness of Biologic Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis After Etanercept Discontinuation in the United Kingdom, France, and Germany

Treatment effectiveness and treatment patterns among rheumatoid arthritis patients after switching from a tumor necrosis factor inhibitor to another medication

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