One-Year Medication Adherence and Persistence in Rheumatoid Arthritis in Clinical Practice: A Retrospective Analysis of Upadacitinib, Adalimumab, Baricitinib, and Tofacitinib

Abstract

Introduction: This study evaluated 12 months adherence and persistence among Janus kinase inhibitors (upadacitinib, baricitinib, tofacitinib) and adalimumab, a tumor necrosis factor inhibitor (TNFi), in patients with rheumatoid arthritis (RA).

Methods: This retrospective analysis used administrative claims data from the Merative™ MarketScan^® Research Databases (2018-2022). Eligible adults had ≥ 1 RA diagnosis before the index date, ≥ 1 pharmacy claim for index medication, and ≥ 12 months of continuous insurance enrollment pre- and post-index. Adherence to treatment [defined as proportion of days covered (PDC) ≥ 80%], risk of treatment discontinuation, and mean time to discontinuation were assessed during the 12 months follow-up. Adjusted odds ratios (aOR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI) were reported.

Results: In total, 6317 patients were included (683 upadacitinib, 3732 adalimumab, 132 baricitinib, 1770 tofacitinib). Compared with upadacitinib, patients initiating adalimumab [aOR (95% CI): 0.82 (0.69, 0.96)], baricitinib [0.46 (0.31, 0.68)], and tofacitinib [0.74 (0.62, 0.88)] were significantly less likely to achieve PDC ≥ 80%. Risk of treatment discontinuation was significantly higher in patients treated with adalimumab [aHR (95% CI): 1.14 (1.01, 1.29)], baricitinib [1.48 (1.16, 1.90)], and tofacitinib [1.22 (1.07, 1.38)] compared with upadacitinib. Mean time to discontinuation was 256 (upadacitinib), 249 (adalimumab), 221 (baricitinib), and 239 (tofacitinib) days. Similar results were observed in patients with prior TNFi use.

Conclusions: Patients with RA, regardless of recent TNFi experience, initiating upadacitinib were significantly more likely to be adherent and less likely to discontinue therapy compared to adalimumab, baricitinib, and tofacitinib in the first 12 months of treatment.

Keywords: Discontinuation; Janus kinase inhibitor; Medication adherence; Real-world; Rheumatoid arthritis; Treatment persistence; Tumor necrosis factor inhibitor; Upadacitinib.

Fig. 1

Patient attrition. FDA US Food and Drug Administration, RA rheumatoid arthritis.^aOn or after August 19, 2019 for upadacitinib (US FDA approval date)^bBaseline defined as the 12-month pre-index period

Fig. 2

Proportion of patients with PDC ≥ 80% and likelihood of adherence at 12 months in all initiators and TNFi-experienced patients treated with UPA versus ADA, BARI, and TOFA. ADA adalimumab, BARI baricitinib, CI confidence interval, PDC proportion of days covered, TNFi tumor necrosis factor inhibitor, TOFA tofacitinib, UPA upadacitinib. *p < 0.05, **p < 0.01, ***p < 0.001

Fig. 3

Proportion of all initiators and TNFi-experienced patients discontinuing treatment and the risk of discontinuation for UPA versus ADA, BARI, and TOFA. ADA adalimumab, BARI baricitinib, CI confidence interval, TNFi tumor necrosis factor inhibitor, TOFA tofacitinib, UPA upadacitinib. *p < 0.05; **p < 0.01