Switching of anti-TNF biologics increases disease burden for patients with RA

SAN FRANCISCO — Patients with rheumatoid arthritis who switched anti-tumor necrosis factor treatments for nonmedical reasons showed poorer outcomes and had a greater likelihood for higher disease activity, incidence of urgent care visits and disease flares, according to research presented at the American College of Rheumatology Annual Meeting.

Douglas C. Wolf, MD , of the Atlanta Gastroenterology Associates said that in clinical practice, patients will ideally continue to receive the same biologic medication if it is effective for a long duration, possibly decades. However, certain circumstances can interrupt treatment.

“There are times when a patient is forced to change treatment,” Wolf said during a press conference, here. “Typically, the cause is financial, such as loss of employment, loss of insurance, insurance formulary preference or costly copays. We conducted a retrospective, real-world study of the issues with investigators from an American Medical Association panel.”

Wolf and colleagues compared 83 patients with rheumatoid arthritis who had a physician-reported stable response to an anti-tumor necrosis factor agent and switched or discontinued treatment to a matching group of 83 patients who continued treatment and visited the same rheumatologist within 60 days. Among the switchers/discontinuer group, 69.9% of patients switched to another biologic while 30.1% discontinued treatment. Patients who switched or discontinued were more likely to be Hispanic, but no other differences were seen between the groups.

During the follow-up period, 48% of patients who switched had well-controlled disease symptoms compared to 84% of patients who remained on the stable treatment. Patients who switched had an adjusted OR of 3.63 for more than one flare and an adjusted OR of 6.05 for the likelihood of one or more urgent care visits. Patients who switched had an adjusted OR of 10.10 for severe disease.

“All of the increased risks were statistically significant,” Wolf said. “Switching statistically leads to a poorer clinical response.” – by Shirley Pulawski

Reference:

Wolf DC, et al. Paper #555. Presented at: American College of Rheumatology Annual Meeting. Nov. 7-11, 2015; San Francisco.

Disclosure: Wolf reports funding from AbbVie. Please see the full study for a list of all other authors’ relevant financial disclosures.