TY - JOUR
T1 - Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis
T2 - A Comparison of Cycling Versus Swapping Strategies
AU - Karpes Matusevich, Aliza R.
AU - Duan, Zhigang
AU - Zhao, Hui
AU - Lal, Lincy S.
AU - Chan, Wenyaw
AU - Suarez-Almazor, María E.
AU - Giordano, Sharon H.
AU - Swint, J. Michael
AU - Lopez-Olivo, Maria A.
N1 - Funding Information:
The authors thank Xerxes Pundole, MD, PhD, and Erica Goodoff in the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center for their assistance with revising the article. They also thank Siddarth Karanth, MD, PhD, and Adriana Ordoñez, PhD, in the Department of Epidemiology and Disease Control, for their input into statistical methods.
Publisher Copyright:
© 2020, American College of Rheumatology
PY - 2021/10
Y1 - 2021/10
N2 - Objective: To evaluate the sequences of tumor necrosis factor inhibitors (TNFi) and non-TNFi used by rheumatoid arthritis (RA) patients whose initial TNFi therapy has failed, and to evaluate effectiveness and costs. Methods: Using the Truven Health MarketScan Research database, we analyzed claims of commercially insured adult patients with RA who switched to their second biologic or targeted disease-modifying antirheumatic drug between January 2008 and December 2015. Our primary outcome was the frequency of treatment sequences. Our secondary outcomes were the time to therapy discontinuation, drug adherence, and drug and other health care costs. Results: Among 10,442 RA patients identified, 36.5% swapped to a non-TNFi drug, most commonly abatacept (54.2%). The remaining 63.5% cycled to a second TNFi, most commonly adalimumab (41.2%). For subsequent switches of therapy, non-TNFi were more common. Patients who swapped to a non-TNFi were significantly older and had more comorbidities than those who cycled to a TNFi (P < 0.001). Survival analysis showed a longer time to discontinuation for non-TNFi than for TNFi (median 605 days compared with 489 days; P < 0.001) when used after initial TNFi discontinuation, but no difference in subsequent switches of therapy. Although non-TNFi were less expensive for adherent patients, cycling to a TNFi was associated with lower costs overall. Conclusion: Even though patients are more likely to cycle to a second TNFi than swap to a non-TNFi, those who swap to a non-TNFi are more likely to persist with the therapy. However, cycling to a TNFi is the less costly strategy.
AB - Objective: To evaluate the sequences of tumor necrosis factor inhibitors (TNFi) and non-TNFi used by rheumatoid arthritis (RA) patients whose initial TNFi therapy has failed, and to evaluate effectiveness and costs. Methods: Using the Truven Health MarketScan Research database, we analyzed claims of commercially insured adult patients with RA who switched to their second biologic or targeted disease-modifying antirheumatic drug between January 2008 and December 2015. Our primary outcome was the frequency of treatment sequences. Our secondary outcomes were the time to therapy discontinuation, drug adherence, and drug and other health care costs. Results: Among 10,442 RA patients identified, 36.5% swapped to a non-TNFi drug, most commonly abatacept (54.2%). The remaining 63.5% cycled to a second TNFi, most commonly adalimumab (41.2%). For subsequent switches of therapy, non-TNFi were more common. Patients who swapped to a non-TNFi were significantly older and had more comorbidities than those who cycled to a TNFi (P < 0.001). Survival analysis showed a longer time to discontinuation for non-TNFi than for TNFi (median 605 days compared with 489 days; P < 0.001) when used after initial TNFi discontinuation, but no difference in subsequent switches of therapy. Although non-TNFi were less expensive for adherent patients, cycling to a TNFi was associated with lower costs overall. Conclusion: Even though patients are more likely to cycle to a second TNFi than swap to a non-TNFi, those who swap to a non-TNFi are more likely to persist with the therapy. However, cycling to a TNFi is the less costly strategy.
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U2 - 10.1002/acr.24358
DO - 10.1002/acr.24358
M3 - Article
C2 - 32558339
AN - SCOPUS:85099398777
SN - 2151-464X
VL - 73
SP - 1461
EP - 1469
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 10
ER -