Treatment patterns in rheumatoid arthritis patients newly initiated on biologic and conventional synthetic disease-modifying antirheumatic drug therapy and enrolled in a North American clinical registry

Abstract

Background Understanding the evolving treatment patterns in patients with rheumatoid arthritis (RA) is important for rheumatologists to make the best practice decisions and optimize treatment. Here, we describe treatment patterns among patients newly initiated on biologic and/or nonbiologic RA therapy over time after enrollment in the US Corrona RA registry. Methods This was a retrospective, cohort study of adult patients with RA enrolled in the Corrona RA registry. Patients were included in this study if they initiated therapy with conventional synthetic disease-modifying antirheumatic drug (csDMARD) monotherapy, TNF inhibitor (TNFi) monotherapy, other (non-TNFi) biologic monotherapy, or combination therapy (index therapy); initiated therapy between January 1, 2004, and December 31, 2015 (index date), after enrollment in the Corrona RA registry; had at least 6 months of follow-up time after the index date; and had at least one follow-up visit. Time periods of interest were based on the year of index therapy initiation: 2004–2007, 2008–2011, and 2012–2015. Results This study included 8027 patients. csDMARD monotherapy and TNFi + csDMARD combination therapy were the most common index therapies in the registry (39.9% and 44.9%, respectively, in the 2004–2007 period; 38.6% and 38.2%, respectively, in the 2008–2011 period; and 35.2% for both in the 2012–2015 period). At therapy initiation, a higher proportion of patients who initiated other biologics, whether as monotherapies (54.0%) or in combination with csDMARD (49.9%), had high disease activity than those who initiated csDMARD monotherapy (28.4%). For 2012–2015 vs 2004–2007 and 2008–2011 periods, persistence on a given therapy appeared to decrease for the TNFi monotherapy cohort (48.2% vs 64.3% and 52.4%) and other biologic monotherapy cohort (52.3% vs 71.4% and 54.5%) over 12 months; switching from one therapy to another was common in the Corrona RA registry. Conclusions Increased switching from one therapy to another and decreased time on a given therapy was observed in the Corrona RA registry in the 2012–2015 period. This observation is most likely due to the increased availability of additional treatment options and/or the change in clinical focus, particularly the emphasis on achievement of treat-to-target goals of remission or low disease activity along with more aggressive treatment.

Patterns in the sequential treatment of rheumatoid arthritis patients starting a b/tsDMARD: 10-year experience from a US-based registry

“…The trend of decreasing therapy duration was observed also in recent work by Mease et al (23), although they used data of patients enrolled in the CorEvitas RA registry between 2004 and 2015 and studied a smaller set of therapies. There exist some studies that have tried to describe sequential therapies using Sankey diagrams (12,13).…”

The beneficial effect of csDMARDs co-medication on drug persistence of first-line TNF inhibitor in rheumatoid arthritis patients: data from Czech ATTRA registry

“…Second, the number of patients starting TNFi in monotherapy was relatively small and represented only 11.5%. Other registries indicate that bDMARDs alone can be given in 30–50% [ 35 , 36 ]. Our smaller proportion of monothorapy might reflect the compliance efforts of physicians working within the ATTRA registry; but, on the other hand, we do not have the reliable data to verify the actual pick-up of csDMARDs in pharmacies, not to mention the gap in the verification of patients compliance with their use at home.…”

Aetiopathogenesis of ischemic stroke in rheumatoid arthritis: a case series study from tertiary care centre of South India

“…8,9 In a North American clinical registry study comprising 8027 COHORTs of RA, it was observed that patients who initiated therapy with conventional synthetic DMARDs monotherapy had low disease activity when compared with those who were initiated with biologics. 10 It had been reported that patients with low disease activity had less chance of developing cerebral vasculitis. Glucocorticoids constituted an effective treatment for CNS rheumatoid vasculitis.…”