Patients with RA who swap to a non-TNF-inhibitor more likely to continue therapy
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Although patients with rheumatoid arthritis who fail initial TNF therapy are more likely to switch to a second TNF inhibitor, those who swap to a non-TNF-inhibitor are more likely to continue with therapy, researchers reported.
“Currently, there is still debate about the best treatment strategy for patients with rheumatoid arthritis if initial treatment with a TNF inhibitor fails,” Aliza R. Karpes Matusevich, PhD, of The University of Texas Health Science Center, told Healio Rheumatology. “Our study compares the costs and time to drug discontinuation of two commonly used approaches: Cycling, or switching to another TNF inhibitor, and swapping, or changing to a drug with another mechanism of action.”
To analyze the use of TNF inhibitors and other drugs, as well as their effectiveness and costs, among patients whose first TNF therapy failed, Matusevich and colleagues analyzed commercial insurance claims from the Truven Health MarketScan Research database. Focusing on the period between January 2008 and December 2015, the researchers included the claims of 10,442 commercially insured adults with RA who switched to a second biological or targeted DMARD.
The primary outcome was the frequency of treatment swaps. Other outcomes included the time to therapy discontinuation, drug adherence and all health care costs.
According to the researchers, 36.5% of included patients switched to nonTNF therapy, with 54.2% of such individuals receiving abatacept (Orencia, Bristol-Myers Squibb). The remaining 63.5% of included patients cycled to a second TNF inhibitor, most commonly adalimumab (Humira, AbbVie). For all subsequent therapy swaps, nonTNF therapy was the more common option. Patients who switched to a nonTNF inhibitor were significantly older and had more comorbidities than those who cycled to another TNF inhibitor (P < .001).
Patients who switched to a non-TNF inhibitor demonstrated a longer time to discontinuation, compared with those who cycled to a second TNF inhibitor (P < .001). Further, although nonTNF therapies were less expensive, cycling to another TNF inhibitor was associated with lower overall costs.
“Our analysis shows that most often, patients who discontinue their initial therapy with a TNF inhibitor are prescribed a second, different TNF inhibitor,” Matusevich said. “However, patients who were ‘swapped’ to a biologic agent with a different mechanism of action were likely to stay on this drug for a longer time. Furthermore, for patients who adhered to their treatment, overall costs were lower for patients who swapped compared to patients who cycled to a different TNF inhibitor.”
She added: “Patients with RA who discontinue their initial TNF inhibitor may benefit from receiving a biologic agent with a different mechanism of action, rather than a second TNF inhibitor, as evidenced by longer time to drug discontinuation.”
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