Treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis

Abstract

OBJECTIVE To evaluate treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis who started therapies with disease-modifying antirheumatic drugs (DMARD) and tumor necrosis factor blockers (anti-TNF drugs).METHODS This retrospective cohort study from July 2008 to September 2013 evaluated therapy persistence, which is defined as the period between the start of treatment until it is discontinued, allowing for an interval of up to 30 days between the prescription end and the start of the next prescription. Odds ratio (OR) with 95% confidence intervals (95%CI) were calculated by logistic regression models to estimate the patients’ chances of persisting in their therapies after the first and after the two first years of follow-up.RESULTS The study included 11,642 patients with rheumatoid arthritis – 2,241 of these started on anti-TNF drugs (+/-DMARD) and 9,401 patients started on DMARD – and 1,251 patients with ankylosing spondylitis – 976 of them were started on anti-TNF drugs (+/-DMARD) and 275 were started on DMARD. In the first year of follow-up, 63.5% of the patients persisted in their therapies with anti-TNF drugs (+/-DMARD) and 54.1% remained using DMARD in the group with rheumatoid arthritis. In regards to ankylosing spondylitis, 79.0% of the subjects in anti-TNF (+/-DMARD) group and 41.1% of the subjects in the DMARD group persisted with their treatments. The OR (95%CI) for therapy persistence was 1.50 (1.34-1.67) for the anti-TNF (+/-DMARD) group as compared with the DMARD group in the first year for the patients with rheumatoid arthritis, and 2.33 (1.74-3.11) for the patients with ankylosing spondylitis. A similar trend was observed at the end of the second year.CONCLUSIONS A general trend of higher rates of therapy persistence with anti-TNF drugs (+/-DMARD) was observed as compared to DMARD in the study period. We observed higher persistence rates for anti-TNF drugs (+/-DMARD) in patients with ankylosing spondylitis as compared to rheumatoid arthritis; and a higher persistence for DMARD in patients with rheumatoid arthritis as compared to ankylosing spondylitis.

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

“…In those studies that examined persistence and discontinuation with biologics across rheumatic conditions, using a consistent in-study method over a comparable time period to our study, persistence was reported as being lower in RA than AS 45 46. This is similar to our findings where patients with RA were most likely to discontinue their index subcutaneous biologic, potentially reflecting the treat-to-target approach and greater therapeutic options available for RA at the time of this study.…”

“…In our Cox regression analyses, female sex was associated with lower persistence being consistent with several studies 43 45 46. However, our findings regarding socieconomic status contradict those of the Machado et al study as we have shown higher persistence in patients with lower deprivation levels.…”

“…Linked prescription and administrative health datasets have been used to study the utilisation of biologics in real-world settings in other studies in Europe, USA, Canada and Brazil 24 28 29 44 45. However, to the best of our knowledge, this is the first study to use routine data generated through ‘direct to home’ deliveries of biologics as a source of information to assess how patients use these medicines.…”

Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review

“…Participants were derived either from the outpatient clinic 27 – 32 or were recruited online 33 through social media or forums, or were patients from established cohorts in medical databases. 24 – 26 , 34 , 35 In two studies, the Danish nationwide DANBIO Registry, which includes clinical data on patients with rheumatic diseases treated with biologics in routine care, was used. 36 , 37 Another study recruited patients through the British Society for Rheumatology Biologics Register for RA – a UK-wide prospective observational cohort study established in 2001 for the purpose of monitoring the long-term safety of biologic therapy.…”

“… 36 , 37 Another study recruited patients through the British Society for Rheumatology Biologics Register for RA – a UK-wide prospective observational cohort study established in 2001 for the purpose of monitoring the long-term safety of biologic therapy. 38 In regard to study design, four had a cross-sectional design, 27 , 28 , 31 , 32 five were retrospective cohort studies, 24 – 26 , 34 , 35 and six were prospective studies. 29 , 30 , 33 , 36 – 38 …”