Although the care of patients with rheumatoid arthritis who have high disease activity has improved substantially over the past 2 decades with the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs), data on population-level time trends in the use of bDMARDs have been relatively scarce. But a new study provides insight on the increasing use—and success—of these agents.
Researchers observed a steady increase in the proportion of patients initiating new bDMARDs, as well as switching between bDMARDs, in both public and private health insurance programs.
“Use of bDMARDs in recent years has contributed to the markedly increased remission rates of RA,” wrote the investigators, led by Rishi J. Desai, MS, PhD, of Brigham and Women’s Hospital and Harvard Medical School. “And sustained remission is known to result in economic benefits to the health care system in the form of reduced use of health services in addition to improved quality of life and patient productivity.”
They reported their findings in the August 2017 issue of the Journal of Managed Care & Specialty Pharmacy.
Unlike older nonspecific immunomodulatory agents, such as methotrexate and hydroxychloroquine, bDMARDs target specific components of the immune system involved in the pathogenesis of rheumatoid arthritis. Currently, 9 targeted bDMARDs are approved for the indication of rheumatoid arthritis: 5 tumor necrosis factor (TNF)-α inhibitors (infliximab, etanercept, adalimumab, certolizumab, and golimumab); 2 interleukin inhibitors (tocilizumab and anakinra); a T-cell activation inhibitor (abatacept); and a CD-20 activity blocker (rituximab). A tenth targeted DMARD approved for rheumatoid arthritis, a janus kinase inhibitor (tofacitinib), is a small molecule-targeted DMARD and not a biologic.
Deriving data from more than 200,000 patients with a diagnosis of rheumatoid arthritis, this study is the largest currently available in the literature that describes time trends in the use of bDMARDs. Data were obtained from private (Optum Clinformatics, 2004-2015) and public (Medicaid Analytic eXtract, 2000-2010) insurance programs. This investigation also is the first detailed report that documents rates of use of bDMARDs in a nationwide population of Medicaid enrollees.
Patients with diagnosis codes for rheumatoid arthritis and continuous health plan enrollment for 1-year baseline and 1-year follow-up periods were identified in 2 separate cohorts. The first cohort included patients not yet using any bDMARD. This group was further stratified by “incident RA,” defined as only 1 RA visit and no DMARD use in the pre-index period, and “prevalent RA,” defined as more than 1 RA visit or the use of non-bDMARDs in the pre-index period. The second cohort included patients who used a single bDMARD during the baseline period.
This study was supported by an investigator-initiated research grant from Pfizer. The authors conducted the study independent of the sponsor.
Desai RJ, Solomon DH, Jin Y, et al. “Temporal Trends in Use of Biologic DMARDs for Rheumatoid Arthritis in the United States: A Cohort Study of Publicly and Privately Insured Patients.” J Manag Care Spec Pharm. 2017;23:809-814. doi: 10.18553/jmcp.2017.23.8.809.