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Non-medical switch of anti-TNF agents may result in increased side effects, lack of efficacy
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Patients with a rheumatic or immune disease, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease or ulcerative colitis, who switched anti-tumor necrosis factor-alpha agents for non-medical reasons experienced reduced efficacy, an increase in side effects, subsequent treatment changes and greater health care utilization, according to research by Allan Gibofsky, MD, JD, FACP, FCLM, and colleagues.
The researchers examined records from the Humedica health care database and identified 158 patients with an immune disease (65% rheumatoid arthritis) who switched anti-tumor necrosis factor-alpha (anti-TNF) agents during a 90-day baseline period. Using a natural language-processing algorithm, motives for switching were identified and included cost, side effects, insurance requirements or lack of efficacy. Patients were matched based on disease, initial anti-TNF therapy, sex and age to 4,804 patients with stable use of the respective anti-TNF therapy, and rates of outpatient utilization were compared between groups at 30, 60 and 90 days and at 1 year.
Allan Gibofsky
A cost-influenced, non-medical switch was associated with a 62% increased likelihood of an additional treatment adjustment linked to side effects or lack of efficacy during 1 year of follow-up compared with a 20% increased likelihood in patients who remained on stable treatment. Additionally, a higher rate of medical care utilization was seen in the group of patients who switched anti-TNF therapies, with a mean number of 13 visits to a health care provider compared with 5.8 visits in the group that did not switch in the first 90 days of treatment. – by Shirley Pulawski
Reference:
Gibofsky A, et al. Paper #SAT0139. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology; June 10-13, 2015; Rome.
Disclosures: Gibofsky reports he is a stockholder in AbbVie, Amgen, BMS, Pfizer, J&J, GSK and Regeneron and is a consultant to AbbVie, Amgen, Pfizer, Horizon, Iroko, Relburn, Celgene, Takeda, Medac Speaker-AbbVie, Amgen, Pfizer and Celgene. Please see the full study for a list of all other authors’ relevant financial disclosures.