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. 2018 Nov 27:10:151-160.
doi: 10.2147/OARRR.S179704. eCollection 2018.

Treatment persistence of subcutaneous TNF inhibitors among Australian patients with immune-mediated rheumatic disease (IMRD)

Mustafa Acar  1 , Prabhjot Juneja  2 , Malcolm Handel  1
Affiliations

Treatment persistence of subcutaneous TNF inhibitors among Australian patients with immune-mediated rheumatic disease (IMRD)

Mustafa Acar et al. Open Access Rheumatol. .

Abstract

Introduction: To describe the persistence of treatment with subcutaneous tumor necrosis factor inhibitors (TNFi) adalimumab, etanercept, and golimumab in immune-mediated rheumatic disease (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) by treatment sequence (first-line treatment, second-line or further lines of treatment).

Methods: A retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme 10% sample data from January 1, 2010, to June 30, 2016. Pharmaceutical Benefits Scheme indications were used to identify patient prescriptions for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A patient was considered persistent until a 3-month gap period where a prescription was not dispensed. The 3-month gap interval was chosen because only 1% of all discontinuations occurred beyond this 3-month period.

Results: Data from 2,612 first-line patients were included. Treatment discontinuation among first-line patients treated with etanercept or adalimumab was not significantly different from those treated with golimumab (HR 1.10, 95% CI 0.95-1.28, P=0.22; HR 1.06, 95% CI 0.93-1.22, P=0.39; respectively). Among the 1,276 patients in the second-line cohort (etanercept=41%, adalimumab=41%, golimumab=18%) discontinuation was significantly higher for patients on etanercept compared with golimumab (HR 1.24, 95% CI 1.03-1.50, P=0.03); but not for adalimumab compared with golimumab (HR 1.11, 95% CI 0.91-1.34, P=0.31). In the third-line setting, treatment persistence with etanercept was longer than golimumab (HR 0.75, 95% CI 0.59-0.96, P=0.02), but there was no difference between golimumab and adalimumab. Similar findings occurred in the propensity score matched population.

Conclusion: Our study shows there is variance in real-world persistence to TNFi in patients with immune-mediated rheumatic disease by line of therapy, with the time on therapy decreasing by line. Australian persistence has been reported at lower overall rates than international evidence.

Keywords: ankylosing spondylitis; arthritis; psoriatic; rheumatoid arthritis; treatment persistence; tumor necrosis factor inhibitors.

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Conflict of interest statement

Disclosure MA and MH are employees of Janssen-Cilag Pty Ltd., who market golimumab (SIMPONI). PJ is an employee of Prospection Pty Ltd. who were contracted by Janssen-Cilag Pty Ltd. to perform the analyses. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A–C) Persistence with treatment (months) in unmatched population by treatment and line of therapy.
Figure 2
Figure 2
(A–D) Persistence with treatment (months) in unmatched population by order of therapy, overall and indication specific.
Figure 3
Figure 3
(A–I) Persistence with treatment (months) in unmatched population by treatment, diagnosis, and line of therapy.
Figure 4
Figure 4
(A–C) Persistence with treatment (months) in propensity score matched populations, by line of therapy.
See this image and copyright information in PMC

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