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Effect of adherence to anti-TNF regimens varies by adherence definition
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In patients with axial spondyloarthritis, the impact of adherence to anti-tumor necrosis factor recommendations is sensitive to the definition of adherence used. This emphasizes the need to refine and validate methods of measuring adherence to axial spondyloarthritis anti-tumor necrosis factor recommendations, according to recently published findings.
Researchers used data from the DESIR cohort, which includes 708 adult patients with inflammatory back pain indicative of spondyloarthritis lasting more than 3 months and less 3 years. Researchers identified 469 patients who met the criteria for axial spondyloarthritis put forth by the Assessment of Spondyloarthritis International Society (ASAS).
They used DESIR data to assess a classification system intended for use with observational data to define adherence to ASAS anti-tumor necrosis factor (anti-TNF) use and other recommendations. In defining anti-TNF adherence, clinicians considered the timing of anti-TNF commencement in relation to disease activity on the bath ankylosing spondylitis disease activity index and the physician’s global assessment. Patients were classified as one of the following: adherent “timely” anti-TNF users; nonadherent “late” anti-TNF users; adherent nonusers (“no anti-TNF need”); or non-adherent nonusers (“unmet anti-TNF need).
In a main analysis and a sensitivity analysis, researchers used two different definitions of anti-TNF recommendation adherence. In the main analysis, “adherent” or timely anti-TNF users were patients with high disease activity at two consecutive visits who received an anti-TNF agent on the second visit. In the sensitivity analysis, these patients were categorized as nonadherent or “late” anti-TNF users. Researchers assessed the effect of anti-TNF adherence on quality-adjusted life years (QALY), total costs and nonbiologic costs 1 year after the index date.
Based on the main analysis definition of adherence, they found no significant difference between late anti-TNF users and timely anti-TNF users in terms of total costs or nonbiologic costs. Based on the definition used in the sensitivity analysis, however, significantly increased nonbiologic costs were seen in late anti-TNF users vs. timely anti-TNF users (risk ratio: 1.58). In a subset analysis of the 20 anti-TNF users classified as adherent in the main analysis and nonadherent in the sensitivity analysis, researchers found these patients had the lowest post-index health status (0.49±0.13), as well as the highest total costs ($19,586), nonbiologic costs ($7,987), nonbiologic health-resource use costs ($3,500) and productivity loss costs ($4,487).
The main analysis showed no significant disparities in QALY between timely anti-TNFF users and late TNF users, or between timely users and nonadherent nonusers. The sensitivity analysis found a significantly lower QALY among nonadherent nonusers vs. timely anti-TNF users.
with smoking and female sex.-by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.
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