Jones G, et al. - In this study, the persistence of biologic disease modifying anti-rheumatic drugs (bDMARDs) in Australian rheumatoid arthritis (RA) patients was reported as well as the impact of methotrexate and other conventional DMARD (cDMARD) concomitant medications, and treatment line on bDMARD persistence and glucocorticoids usage was assessed. Findings demonstrated that treatment persistence was longer on tocilizumab followed by abatacept then sub-cutaneous anti-tumor necrosis factor therapy and was impacted by co-therapy. With bDMARD use, glucocorticoid dosage decreased. Overall, according to the biologics mode of action and co-therapy, persistence on bDMARDs differed.

Methods

• This study was performed on RA patients, from the 10% Australian Medicare random sample, aged ≥18 for whom bDMARDs were dispensed.
• Individual sub-cutaneous (SC) anti-tumor necrosis factor-α (anti-TNFα) agents were combined as they were equivalent.

Results

• This analysis included data from 1230 patients.
• The 12-month persistence rates (based on Kaplan–Meier estimates) for all patients were as follows: 76% for intravenous (IV) tocilizumab, 63% abatacept (SC/IV), 61% SC-anti-TNFs and 36% IV-infliximab.
• Data showed that 79% (tocilizumab and abatacept), 64% (SC-anti-TNFs) and 13% (infliximab) were the documented persistence rates on first-line bDMARDs; rates were sustained for tocilizumab but dropped to 49% for abatacept and 51% for SC-anti-TNFs in the second-line setting.
• Researchers noted that median treatment persistence was 40 months tocilizumab (95% CI: 30-ND), 33 months abatacept (95% CI: 20-ND); 22 months SC-anti-TNF (95% Cl: 18–27), and 4 months infliximab (95% CI: 2–13).
• For SC-anti-TNFs and abatacept combined with methotrexate or other cDMARDs, longer persistence was observed.
• In addition, robust persistence was reported for tocilizumab with or without concomitant medications.
• Over 2 years, decline was noted in the median oral glucocorticoid doses, from 4.1 mg/day (min 0, max 21) to 2.0 mg/day (min 0, max 17.3).