Session Information
Session Type: ACR Plenary Session
Session Time: 11:00AM-12:30PM
Background/Purpose:
MTX is the anchor DMARD for RA treatment, but there is limited information about its appropriate use in clinical practice. This claims analysis was aimed at gaining insight into how MTX is employed for RA treatment in the US.
Methods: The analysis used Symphony Health Solutions’ anonymized patient-level claims data which captures ~274 million US patients. The analysis included RA patients identified by ICD-9 codes 714.0 and 714.30 who initiated treatment with oral MTX in 2009 and were followed to 2014. Information obtained included: demographic characteristics, switches from oral to subcutaneous (SC) MTX and/or biologics (with or without concomitant MTX), timing of treatment changes, and oral MTX or SC MTX dosing at the times of switches/additions or end of follow-up. Independent t-tests were used to assess significance of differences among treatment paths.
Results: The study included 35,640 patients (Table). Of these, 15,599 (43.8%) continued on oral MTX alone (Group 1), through the end of the follow-up period and 17,528 (49.2%) added or switched to a biologic agent (Group 2). The median time to adding a biologic in Group 2 was 170 days and 41.5% of the patients added a biologic within 90 days of initiating oral MTX. In addition, only 7% of patients switched from oral to SC MTX (Group 3) after a median of 534 days of oral therapy; 14.0% of these patients switched within the first 90 days of oral MTX treatment. Overall, 71% of patients who switched from oral to SC MTX remained on this treatment for approximately 3 years and those who added a biologic did so after a median of 289 days. Median time for progression to a biologic was significantly longer (823 days; time on oral + time on SC) for patients who received SC MTX vs those who received only oral drug (170 days) (P<0.0001).
|
Oral MTX Initiation 2009 N=35,640 |
|
Duration of Oral MTX Prior to Biologic (days) |
Oral MTX Dose Prior to Biologic (mg/week) |
SC MTX Dose Prior to Biologic (mg/week) |
Duration of SC MTX Prior to Biologic (days) |
MTX Dose at Last Follow-up 2014 (mg/week) |
|
n (%) |
Mean ± SD Median |
|||||
|
Group 1: Remained on only oral MTX through 2014 |
15,599 (43.8%) |
NA |
NA |
NA |
NA |
15 ± 5 15 |
|
Group 2: Biologic initiated during follow-up period |
17,528 (49.2%) |
478 ± 580 170 |
15 ± 5 15 |
NA |
NA |
NA |
|
Group 3: Switched from oral to SC MTX and remained on this treatment or had biologic added |
2,513 (7.0%) |
729 ± 6231 534 |
17 ± 51 15 |
21 ± 52 20 |
457 ± 4562 289 |
21 ± 53 20 |
|
1. P<0.0001 vs Group 2 2. For 711 patients who switched to a biologic 3. For 1,802 patients who remained on SC MTX until the end of follow-up |
||||||
Conclusion:
In the US, MTX is frequently under-dosed, given for an inadequate length of time, and rarely switched to SC before the initiation of biologic therapy. More than 40% of RA patients who initiate treatment with oral MTX switched to or had a biologic added within 90 days after a median dose of only 15 mg/week. Switching to SC MTX prevents the need for or significantly extends time to a biologic. More appropriate optimization of MTX could lead to better control of RA and would be expected to produce significant cost savings.
To cite this abstract in AMA style:
O'Dell JR, Rohr M, Cohen SB, Thorne JC, Mikuls TR. Underuse of Methotrexate (MTX) in the Treatment of Rheumatoid Arthritis (RA) in the United States (US): Results of a Comprehensive Pharmaceutical Claims Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/underuse-of-methotrexate-mtx-in-the-treatment-of-rheumatoid-arthritis-ra-in-the-united-states-us-results-of-a-comprehensive-pharmaceutical-claims-analysis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/underuse-of-methotrexate-mtx-in-the-treatment-of-rheumatoid-arthritis-ra-in-the-united-states-us-results-of-a-comprehensive-pharmaceutical-claims-analysis/