Higher Medication Adherence and Lower Opioid Use Among Individuals with Autoimmune Disease Enrolled in an Adalimumab Patient Support Program in the United States

Abstract

Introduction: Opioid use is prevalent among patients with autoimmune conditions, despite not being a recommended treatment. Tumor necrosis factor inhibitor (anti-TNF) therapy is an effective treatment for these autoimmune conditions, and patient support programs (PSPs) have been developed to help patients manage their prescribed treatments. This study was conducted to evaluate the impact of PSPs on anti-TNF adherence and opioid use using data on adalimumab (ADA), an anti-TNF.

Methods: The study used insurance claims data linked to ADA PSP data on patients who initiated ADA after 01/2015, were commercially insured, and had data coverage for 1 year before and after (i.e., during the follow-up period) ADA initiation. Patients with opioid use in the 3 months before ADA initiation were excluded. PSP patients enrolled in the PSP within 30 days of ADA initiation and had 2+ PSP nurse ambassador interactions; non-PSP patients had no PSP engagement. ADA adherence [proportion of days covered (PDC), persistence], opioid initiation, 2+ opioid fills, and opioid supply during follow-up were compared between cohorts using regression models that controlled for patient characteristics.

Results: Results were obtained for 1952 PSP and 728 non-PSP patients. PSP patients demonstrated better adherence to ADA than non-PSP patients, including higher PDC and persistence (all p < 0.001). PSP patients were 13% less likely to initiate opioids and 26% less likely to have at least 2 fills than non-PSP patients, and they had fewer days of opioid supply (all p < 0.01).

Conclusions: This study supports the benefit of PSPs and suggests that the ADA PSP is associated with improved adherence and potentially lower opioid use.

Keywords: Adalimumab; Autoimmune disorder; Opioid; Patient support program; Treatment adherence.

Fig. 1

Selection of the study population. ADA adalimumab, N/A not applicable, PSP patient support program, TNF tumor necrosis factor

Fig. 2

a Initiation of opioids¹ during follow-up. b Days of opioid supply during follow-up. PSP patient support program. * p < 0.05 in the unadjusted model. ¹ Initiation of opioids was defined as having any opioid fills during the follow-up period. Mean days of opioid supply among patients who initiated opioids during the follow-up period were reported. The proportions and means presented in the figure are raw, unadjusted values. ² Adjusted p values were estimated using multivariable regression models adjusting for age, sex, Charlson Comorbidity Index, index autoimmune disease, bionaïveté at index date, and the baseline value of the outcome variable (e.g., for the regression of at least two opioid fills during the follow-up period, the regression controlled for having at least two opioid fills during the baseline)

Fig. 3

Days of opioid of supply during follow-up. PSP patient support program. Proportions presented are raw, unadjusted values; * indicates p < 0.05 in unadjusted model. ¹ Adjusted p values were estimated using multivariable logistic regression models adjusting for age, sex, Charlson Comorbidity Index, index autoimmune disease, bionaïveté at index date, and the baseline value of the outcome variable (e.g., for the regression of at least 15 days of opioid supply during the follow-up period, the regression controlled for having at least 15 days of opioid supply during the baseline)