Triple Therapy Versus Biologic Therapy for Active Rheumatoid Arthritis

Bansback, Nick; Sun, Huiying; O'Dell, James Robert; Brophy, Mary; Keystone, Edward; Leatherman, Sarah; Mikuls, Ted R.; Anis, Aslam H.; Ayoub, William T.; Boire, Gilles; Bykerk, Vivian P.; Chow, Andrew; Colburn, Keith K.; Daikh, David I.; Davis, John M.; El-Gabalawy, Hani; Elliott, J; Fanciullo, Joseph; Gupta, Samardeep; Hannagan, Keri; Hausch, Raymond; Holmberg, Erika; Joseph, Anthony J.; Kazi, Salahuddin; Kent, Peter D.; Kerr, Gail S.; Kolba, Karen S.; Kwoh, C. Kent; Mahowald, Maren L.; Martin, Liam; Olenginski, Thomas P.; Persselin, Jay E.; Peshimam, Mahfooz; Peterson, Lynne S.; Prete, Pamela E.; Pugliese, David; Reddy, Virginia; Reimold, Andreas M.; Rodrigues, J.; Schumacher, H. Ralph; Thorne, John; Valeriano-Marcet, Joanne; Weaver, Cynthia; Phibbs, Ciaran S.

doi:10.7326/m16-0713

Cited by 49 publications

(37 citation statements)

References 30 publications

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“…For example, the examination of infliximab (TNFi) by Eriksson et al (28) against conventional combination treatment reached similar conclusions of greater costs and lack of cost-effectiveness for the TNFi in a comparable trial-based economic evaluation covering 21 months. The only other head-to-head trial in established RA (Rheumatoid Arthritis Comparison of Active Therapies Trial [30]) similarly concludes that initiating biologics before triple therapy (combination csDMARDs) is not cost effective. Using modeling, Stevenson et al (31) argue that, in England, the cost-effectiveness of biologics for RA is questionable and will only be economically worthwhile in those with the worst prognoses.…”

Section: Discussionmentioning

confidence: 99%

Cost‐Effectiveness of Combination Disease‐Modifying Antirheumatic Drugs Versus Tumor Necrosis Factor Inhibitors in Active Rheumatoid Arthritis: A Pragmatic, Randomized, Multicenter Trial

Patel¹,

Heslin

Scott

et al. 2020

Arthritis Care & Research

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Objective To determine whether intensive combinations of conventional synthetic disease‐modifying antirheumatic drugs (csDMARDS) achieve similar clinical benefits more cheaply than high‐cost biologics such as tumor necrosis factor inhibitors (TNFi) in patients with active rheumatoid arthritis (RA) whose illness has failed to respond to methotrexate and another DMARD. Methods We used within‐trial cost‐effectiveness and cost‐utility analyses from health and social care and 2 societal perspectives. Participants were recruited into an open‐label, 12‐month, pragmatic, randomized, multicenter, 2‐arm, noninferiority trial in 24 rheumatology clinics in England and Wales. Costs were linked with the Health Assessment Questionnaire (HAQ; primary outcome) and quality‐adjusted life years derived from 2 measures (Short‐Form 36 health survey and EuroQol 5‐domain 3‐level instrument). Results In total, 205 participants were recruited, 104 in the csDMARD arm and 101 in the TNFi arm. Participants in the csDMARD arm with poor response at 6 months were offered TNFi; 46 participants (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6‐month follow‐up and for 91–92% of participants at 12‐month follow‐up. The csDMARD arm had significantly lower total costs from all perspectives (6‐month health and social care adjusted mean difference –£3,615 [95% confidence interval (95% CI) –4,104, –3,182]; 12‐month health and social care adjusted mean difference –£1,930 [95% CI –2,599, –1,301]). The HAQ score showed benefit to the csDMARD arm at 12 months (–0.16 [95% CI –0.32, –0.01]); other outcomes/follow‐ups showed no differences. Conclusion Starting treatment with csDMARDs, rather than TNFi, achieves similar outcomes at significantly lower costs. Patients with active RA and who meet the National Institute for Health and Care Excellence criteria for expensive biologics can be treated with combinations of intensive csDMARDs in a cost‐effective manner.

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Section: Discussionmentioning

confidence: 99%

Cost‐Effectiveness of Combination Disease‐Modifying Antirheumatic Drugs Versus Tumor Necrosis Factor Inhibitors in Active Rheumatoid Arthritis: A Pragmatic, Randomized, Multicenter Trial

Patel¹,

Heslin

Scott

et al. 2020

Arthritis Care & Research

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“…Die Kostenfrage von Therapiemodalitäten tritt zunehmend in den Vordergrund der Diskussionen und fließen in die Empfehlungen ein [3,6,[10][11][12][13][14][15]. Diese Notwendigkeit erschließt sich über die Zulassung v. a. hochpreisiger spezifischer Medikamentenentwicklungen der letzten zwei Jahrzehnte.…”

Section: Empfehlungen Und Leitlinienunclassified

Auswahl klinischer und diagnostischer Ergebnisse bei entzündlichen Gelenkerkrankungen

Detert

2018

Akt Rheumatol

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ZusammenfassungZahlreiche Fortschritte in der Grundlagenforschung, in der Diagnostik und Therapie in den letzten Jahren führen dazu, dass Patienten mit einer entzündlichen Gelenkerkrankung eine Remission bzw. niedrigstmögliche Krankheitsaktivität, Lebensqualität, einen Erhalt ihrer Arbeitsfähigkeit als auch das Beibehalten der sozialen Integration beibehalten. Diese Erfolge werden schrittweise versucht, auf andere Autoimmunerkrankungen zu übertragen. Es zeigt sich gerade auf dem Gebiet der Medikamentenentwicklung jedoch immer wieder, dass es sich um pathogenetisch unterschiedlich verursachte Erkrankungen handelt und Therapieerfolge nicht immer gleichermaßen erreichbar sind. Jedoch sind inzwischen zahlreiche Medikamente zur Behandlung der entzündlichen Gelenkerkrankungen verfügbar, weitere werden derzeit intensiv in klinischen Studien geprüft bzw. sind zur Zulassungsentscheidung bei den Aufsichtsbehörden registriert. So sind auch in den nächsten Jahren weitere Therapiemöglichkeiten zu erwarten. Die rheumatoide Arthritis ist ein Beispiel dieser Erfolgsgeschichte, so dass inzwischen sogar die Frage diskutiert wird, ob diese Erkrankung präventiv zu behandeln und somit die Manifestation der Erkrankung zu stoppen ist. Diese Übersicht vermittelt eine Auswahl aktueller Forschungsergebnisse und Medikamentenentwicklungen bei entzündlichen Gelenkerkrankungen.

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“…One study through the Veterans Hospital showed that this occurred in only 2.5% of patients. Bansback et al recently published a study comparing the costeffectiveness of proceeding directly to etanercept when RA fails to respond to methotrexate [20]. Using data from 324 RACAT study participants, they calculated the costs and quality-adjusted life-years (QALY) for both treatment strategies.…”

Section: Commentarymentioning

confidence: 99%

Therapies for Active Rheumatoid Arthritis after Methotrexate Failure

Mahajan¹,

O'Dell²

2017

Rheumatology

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Rheumatoid arthritis (RA) is a common autoimmune inflammatory arthritis with a one percent prevalence worldwide. Left untreated, it leads to chronic progressive joint disease. Joint damage and erosions develop within two years of disease onset in a majority of patients, and early control of disease activity has been shown to improve long-term outcomes. Methotrexate has long been the staple of RA treatment and has been proven effective as a disease modifying agent in RA, as well as proven to decrease mortality in RA patients. While about twenty-five percent of patients achieve good response with methotrexate alone, the rest require additional or other therapy. This review discusses some of the sentinel trials looking at how best to treat RA patients who have failed methotrexate therapy. In particular, it focuses on the trials comparing triple therapy to biologics. It also addresses the tolerability and cost associated with some of these therapies. The next decade will bring more treatment options, and hopefully, more answers with regards to how to provide the best value therapy for each individual patient.

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Triple Therapy Versus Biologic Therapy for Active Rheumatoid Arthritis

Abstract: The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.

Cited by 49 publications

References 30 publications

Cost‐Effectiveness of Combination Disease‐Modifying Antirheumatic Drugs Versus Tumor Necrosis Factor Inhibitors in Active Rheumatoid Arthritis: A Pragmatic, Randomized, Multicenter Trial

Cost‐Effectiveness of Combination Disease‐Modifying Antirheumatic Drugs Versus Tumor Necrosis Factor Inhibitors in Active Rheumatoid Arthritis: A Pragmatic, Randomized, Multicenter Trial

Auswahl klinischer und diagnostischer Ergebnisse bei entzündlichen Gelenkerkrankungen

Therapies for Active Rheumatoid Arthritis after Methotrexate Failure

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