Public insurance leads to faster bDMARD initiation in juvenile idiopathic arthritis
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WASHINGTON — Patients with juvenile idiopathic arthritis receive biologic disease-modifying antirheumatic drugs significantly sooner on public insurance vs. private, particularly if they have oligoarticular JIA, according to a speaker.
“A biologic DMARD therapy, or bDMARD therapy, is recommended for JIA if conventional DMARDs, such as methotrexate or leflunomide, are not effective,” Elaine Yung, PharmD, of Cincinnati Children’s Hospital Medical Center, told attendees at ACR Convergence 2024. “Some studies have also shown that early utilization of biologic DMARDs may improve outcomes for patients.”
In addition, a previous study showed that “patients with public insurance were escalated up to TNF inhibitor therapies much faster compared to those with private insurance,” Yung added. With all this in mind, Yung and colleagues set out to determine how the initiation of biologic DMARDs, and the time to achieving a clinically inactive disease state, varies with insurance type.
The researchers conducted a retrospective study of 1,127 patients newly diagnosed with JIA at Cincinnati Children’s Hospital Medical Center between 2009 and 2020. After stratification by insurance type, the researchers assessed the time from diagnosis to biologic DMARD initiation, and from initiation to clinically inactive disease, measured using the clinical Juvenile Arthritis Disease Activity Score (cJADAS) and the Physician’s Global Assessment (PGA).
Overall, 74.1% (n = 835) of patients had private insurance and 25.9% (n = 292) had public insurance. Meanwhile, 60.3% (n = 679) initiated biologic DMARDs and 26.4% (n = 298) achieved clinically inactive disease.
According to the researchers, the analysis revealed significant differences between insurance types. Following diagnosis, publicly insured patients started biologic DMARDs significantly earlier than those on private insurance — at 197 days vs. 273 days (P = .09) — but also experienced a significantly longer time to clinically inactive disease — at 431 days vs. 307 days (P < .005).
Differences between insurance type were particularly notable among patients with oligoarticular JIA. Those on public insurance received biologic DMARDs significantly earlier — at 815 days vs. 2,093 days (P < .05) — but time to clinically inactive disease was significantly shorter with private insurance — at 240 days vs. 462 days (P < .05).
According to Yung, the findings pave the way for more granular questions to be answered.
“This opened the option for new studies to be explored within our clinic, such as distance to medical center,” she said. “If a patient is living farther away from the clinic, do they have transportation barriers that are impacting their ability to reach clinically inactive disease, even if they are started on a biologic DMARD faster?”
Other variables to explore include adherence to treatment, comorbid conditions, environmental factors and pollution, Yung added.
“Social deprivation indexes are something we are also looking at, such as if certain ZIP codes have a lower income base, which might impact clinically inactive disease response,” she said.
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Yung E. Abstract #2653. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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