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Insurance Type Linked With Biologic Treatment for Patients With RA
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Among patients with rheumatoid arthritis, insurance type as well as race, previous steroid use and non-biologic disease-modifying antirheumatic drug use were linked with initial or subsequent treatment with biologic disease-modifying antirheumatic drugs.
“In this large cohort study using data from both Medicaid and a commercial health plan, patients enrolled in the commercial insurance plan were more likely to initiate a biologic DMARD than those enrolled in Medicaid,” Seoyoung C. Kim, MD, ScD, MSCE, from Brigham and Women’s Hospital and Harvard Medical School, told Healio Rheumatology. “Among Medicaid enrollees, race was strongly associated with initial and subsequent treatment with biologic DMARDs. Not surprisingly, prior use of steroids and conventional DMARDs were strongly associated with biologic DMARD initiation and subsequent switching.”
Researchers performed an observational cohort study of claims data from a commercial health plan between 2004 and 2013, as well as Medicaid data from 2000 to 2010 for a total of 195,433 patients with rheumatoid arthritis (RA). Of these patients, 40% of whom had early untreated RA; 48% had RA without prior biologic treatment; and 12% who had been previously treated with biologics.
Investigators found initiation with a biologic was more likely to occur in patients with commercial insurance vs. patients on Medicaid (odds ratio [OR] = 1.87). For patients on Medicaid, African-Americans — compared with non-Hispanic whites — were less likely to initiate (OR = 0.59) or to switch (OR = 0.71) biologics. In addition, prior steroid use and previous non-biologic DMARD use were predictive for both biologic initiation and subsequent switching. The most common first-line and second-line biologics were etanercept, adalimumab and infliximab. Furthermore, patients on anakinra and golimumab were the most likely to switch to other biologics. – by Will A. Offit
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Gregg J. Silverman, MD
In the recent paper, Vital and colleagues reported on the off-label use of rituximab for the treatment of SLE. They found a subset of patients had secondary non-responses upon retreatment. The authors provided their insights on how to best recapture efficacy.
In the open-label study, they evaluated 77 patients who were re-treated at the time of clinical relapse. Where 15 patients of the 77 patients had little or no subsequent response, nine patients (~12%) were designated as secondary non-responders and tested positive for anti-rituximab antibodies, which they found correlated with incomplete blood Bcell depletion at 6 weeks after retreatment. Here, responses in these patients were often recovered with newer humanized anti-CD20 agents, ocrelizimab or ofatumamab, which have been approved for the treatment of multiple sclerosis and rheumatoid arthritis, respectively.
While this highlights a special challenge associated with the treatment of patients with SLE, these more recently introduced anti-CD20 agents were suggested to provide alternatives for lupus patients with inadequate responses to other therapeutic regimens.
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