Patient Support Programs Reduce Opioid Use in Patients With Autoimmune Conditions

A combination of adalimumab (ADA) treatment and patient support programs (PSPs) may reduce opioid use and increase medication adherence.

Patient support programs (PSPs), specifically the adalimumab (ADA) PSP, were able to lower opioid use and increase adherence to medication in patients with rheumatic diseases, according to a study published in Springer.1

Although opioids are not a recommended treatment for patients with autoimmune conditions, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), many patients use them regularly. ADA, a tumor necrosis factor inhibitor (anti-TNF), is a safe and effective treatment for these diseases. That, coupled with PSPs designed to help patients manage their treatments, can aid in lowering opioid use in this patient population, thus reducing the risk of misuse, abuse, and mortality.

“The prevalence of opioid use is high among the general population and even more so among patients with autoimmune conditions, despite opioid analgesics not being a recommended treatment for these patients,” stated investigators. “Given the reported risks associated with opioid use, it is vital to help patients reduce their risk for extended use.”

The study used real-world claims data from the Symphony Health Solutions (SHS) database between January 2006 and October 2018. Data included medical and pharmacy claims, which covered more than 280 million people and a variety of payers. The PSP analyzed was HUMIRA Complete, which utilized ADA treatment and helped patients with financial assistance, product education, medication reminders, provided a sharps container for disposing of pens and syringes, an injection training program, transportation, and support via a nurse ambassador program.

Eligible patients were aged ≥ 18 years, commercially insured, and initiated ADA treatment between January 2015 and October 2018. They were then placed into 2 cohorts: PSP and non-PSP. Patients in the PSP enrolled in the PSP within 30 days of the index date and used the nurse ambassador program.

ADA adherence, which includes proportion of days covered (PDC) and persistence, opioid initiation, 2+ opioid fills, and opioid supply were compared between the 2 groups. Results were controlled for patient characteristics.

In total, 1952 patients were enrolled in the PSP cohort and 728 were enrolled in the non-PSP cohort. The patients in the PSP cohort reported better adherence to ADA during the 12-month follow up, including higher PDC (62.5% vs. 46.9%, adjusted p < 0.001) and persistence (44.8% vs. 29.4%, adjusted p < 0.001). Additionally, patients in this group were 13% less likely to start opioids (38.1% vs. 44.0%, adjusted p < 0.01) and 26% less likely to have 2 or more opioid fills when compared with the non-PSP cohort (18.9% vs. 25.5%, adjusted p < 0.001). The PSP cohort continued ADA treatment 23% longer than the non-PSP patients (248.2 vs. 191.5 days, adjusted p < 0.001). Patients in the PSP cohort had lower numbers of days of opioid supply when compared with the non-PSP cohort (27.9 days vs. 37.3 days, adjusted p < 0.01).

The study was limited by the differences between the PSP and non-PSP cohorts, as patients were able to choose whether or not to participate. However, the study lessens the impact by comparing patient characteristics in the statistical analyses. It also focused on patients who were not dependence on opioids, so the results may not be the same as other patient populations or PSPs. Further, patients with government-provided insurance were not eligible to use the PSP services.

“We find that participation in the PSP is associated with increased ADA adherence, lower rates of opioid initiation, and, among those who did initiate, a lower extent of opioid use,” concluded investigators. “While further research is needed to understand the specific mechanisms behind these results, they point to the potential benefits of improved medication-taking behavior and better disease control that may be brought on by PSP participation.”

Reference:

Fendrick AM, Macaulay D, Goldschmidt D, et al. Higher Medication Adherence and Lower Opioid Use Among Individuals with Autoimmune Disease Enrolled in an Adalimumab Patient Support Program in the United States [published online ahead of print, 2021 Apr 25]. Rheumatol Ther. 2021;10.1007/s40744-021-00309-9. doi:10.1007/s40744-021-00309-9