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. 2020 Jun;7(2):383-400.
doi: 10.1007/s40744-020-00203-w. Epub 2020 Apr 21.

Biologic Disease-Modifying Antirheumatic Drug Prescription Patterns for Rheumatoid Arthritis Among United States Physicians

Emma Sullivan  1 , Jim Kershaw  1 , Stuart Blackburn  1 , Jeannie Choi  2 , Jeffrey R Curtis  3 , Susan Boklage  4
Affiliations

Biologic Disease-Modifying Antirheumatic Drug Prescription Patterns for Rheumatoid Arthritis Among United States Physicians

Emma Sullivan et al. Rheumatol Ther. 2020 Jun.

Abstract

Introduction: Some patients with rheumatoid arthritis (RA) using tumor necrosis factor inhibitors (TNFi) experience inefficacy or lack of tolerability and hence switch to another TNFi (cycling) or to a therapy with another mode of action (switching). This study examined patient characteristics, prescribing patterns and treatment practice for RA in the United States.

Methods: Data were from the Adelphi Disease Specific Programme (Q2-Q3 2016). Rheumatologists completed a survey and patient record forms for adult patients with RA who had received ≥ 1 targeted therapy. Patients were grouped by class of first-used targeted therapy, and monotherapy vs. combination therapy. TNFi patients who received ≥ 1 targeted therapy were classified as cyclers or switchers. Univariate analyses compared patient characteristics and physician factors across the analysis groups.

Results: Overall, 631 patients received ≥ 1 targeted therapy; 535 were prescribed a TNFi as first targeted therapy, 53 a nonTNFi biologic disease-modifying antirheumatic drug (bDMARD), and 43 tofacitinib. Of 577 patients with known conventional synthetic (cs) DMARD status, 18.7% were prescribed monotherapy and 81.3% combination therapy. Combination therapy patients received significantly more concomitant medications prior to initiation of first targeted therapy than monotherapy patients (P < 0.05). The top reason for physicians to prescribe first use targeted therapy was strong overall efficacy (79.9%). Of 163 patients who progressed to second targeted therapy, 60.7% were cyclers. A lower proportion of cyclers persisted on their first use targeted therapy versus switchers (P = 0.03). The main reason physicians gave for switching patients at this stage was worsening condition (46.6%).

Conclusions: Most patients were prescribed a TNFi as their first targeted therapy; over half then cycled to another TNFi. This suggests other factors may influence second use targeted treatment choice and highlights the need for greater understanding of outcomes associated with subsequent treatment choices and potential benefits of switching.

Keywords: Biologic disease-modifying antirheumatic drugs; Cycling; Rheumatoid arthritis; Switching; Tumor necrosis factor inhibitors.

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Conflict of interest statement

Emma Sullivan, Jim Kershaw and Stuart Blackburn were employees of Adelphi Real World at the time of this analysis, a company that received funding for the current study from Sanofi and Regeneron Pharmaceuticals, Inc. Jeannie Choi was an employee of and stockholder in Sanofi at the time of this analysis and is now self-employed. Susan Boklage is an employee of and stockholder in Regeneron Pharmaceuticals, Inc. Jeffrey Curtis is a consultant to Sanofi and Regeneron Pharmaceuticals, Inc.

Figures

Fig. 1
Fig. 1
Top 10 reasons for physicians choosing the first targeted therapy. TNFi tumor necrosis factor inhibitor. P value: TNFi versus nonTNFi (identified as nonTNFi biologic disease-modifying antirheumatic drug and tofacitinib)
Fig. 2
Fig. 2
Kaplan–Meier survival estimates for time to discontinuation of first targeted therapy for TNFi versus nonTNFi versus tofacitinib. TNFi, median time to discontinuation (95% confidence interval): 3 (2.5, 4). NonTNFi, median time to discontinuation (95% confidence interval): 4 (2, –). Oral tofacitinib, median time to discontinuation (95% confidence interval): – (2, –). Log rank test for equality of survivor functions: P = 0.3642. TNFi tumor necrosis factor inhibitor
Fig. 3
Fig. 3
Kaplan–Meier survival estimates for time to discontinuation of first targeted therapy for monotherapy versus combination therapy. Monotherapy, median time to discontinuation (95% confidence interval): 2.83 (2, –). Combination, median time to discontinuation (95% confidence interval): 4.0 (3, 5). Log rank test for equality of survivor functions: P = 0.3521
Fig. 4
Fig. 4
Top 10 overall physician reasons for switching therapy following initial TNFi therapy. Categories were not mutually exclusive, and data was for overall available population. P value: TNFi versus nonTNFi (identified as nonTNFi bDMARD and tofacitinib). bDMARD biologic disease-modifying antirheumatic drug, MOA mechanism of action, TNFi tumor necrosis factor inhibitor
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