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. 2019 Mar;46(3):237-244.
doi: 10.3899/jrheum.180071. Epub 2018 Nov 15.

Uptake and Clinical Utility of Multibiomarker Disease Activity Testing in the United States

Jeffrey R Curtis  1   2 , Fenglong Xie  3   4 , Shuo Yang  3   4 , Maria I Danila  3   4 , Justin K Owensby  3   4 , Lang Chen  3   4
Affiliations

Uptake and Clinical Utility of Multibiomarker Disease Activity Testing in the United States

Jeffrey R Curtis et al. J Rheumatol. 2019 Mar.

Abstract

Objective: The clinical utility of the multibiomarker disease activity (MBDA) test for rheumatoid arthritis (RA) management in routine care in the United States has not been thoroughly studied.

Methods: Using 2011-2015 Medicare data, we linked each patient with RA to their MBDA test result. Initiation of a biologic or Janus kinase (JAK) inhibitor in the 6 months following MBDA testing was described. Multivariable adjustment evaluated the likelihood of adding or switching biologic/JAK inhibitor, controlling for potential confounders. For patients with high MBDA scores who added a new RA therapy and were subsequently retested, lack of improvement in the MBDA score was evaluated as a predictor of future RA medication failure, defined by the necessity to change RA medications again.

Results: Among 60,596 RA patients with MBDA testing, the proportion adding or switching biologics/JAK inhibitor among those not already taking a biologic/JAK inhibitor was 9.0% (low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Similarly, among those already taking biologics/JAK inhibitor, the proportions were 5.2%, 8.3%, and 13.5% (p < 0.0001). After multivariable adjustment, referent to those with low disease MBDA scores, the likelihood of switching was 1.51-fold greater (95% CI 1.35-1.69) for patients with moderate MBDA scores, and 2.62 (2.26-3.05) for patients with high MBDA scores. Among those with high MBDA scores who subsequently added a biologic/JAK inhibitor and were retested, lack of improvement in the MBDA score category was associated with likelihood of future RA treatment failure (OR 1.61, 95% CI 1.27-2.03).

Conclusion: The MBDA score was associated with both biologic and JAK inhibitor medication addition/switching and subsequent treatment outcomes.

Keywords: BIOLOGICS; BIOMARKER; MEDICATION PERSISTENCE; MEDICATION SWITCHING; RHEUMATOID ARTHRITIS.

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Figures

None
Annualized rate of biologic or JAKi addition/switching, by MBDA test score utilization (n=3,953 eligible rheumatologists) JAKi : Janus Kinase inhibitor; MBDA: Multi-biomarker disease activity; RA: Rheumatoid arthritis. Rank 0 refers to physicians who did not order the MBDA test for any RA patient with fee-for-service Medicare in that year. Ranks 1–4 correspond to the first (lowest) to fourth (highest) quartiles of MBDA test utilization in the practices of clinicians who ordered the test at least once inthat year. Analysis was restricted to rheumatologists who cared for at least 10 RA patients in each pairwise year comparison. The p-value for test for interaction between year and rank is 0.55.
Figure 1
Figure 1
Utilization of MBDA Testing and Uptake by U.S. Rheumatologists among Medicare Enrollees with RA
Figure 2
Figure 2
Distribution of the Proportion of RA Patients Tested at Least Once with the MBDA within each Rheumatologist’s Practice and who had at least 10 RA patients in 2015 (n=1,426) The solid black horizontal line refers to the proportion of patients tested in the median physician’s practice, and the diamond represents the mean proportion tested.
Figure 3
Figure 3
Patterns of Adding or Switching Biologics or JAKi*, According to MBDA Score (N=60,596) JAKi : Janus kinase inhibitor; MBDA: Multi-biomarker disease activity. * addition or switching between day 4 and 183 after the MBDA test
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