Background/Purpose: Treatment of rheumatoid arthritis (RA) with biologics is increasingly common. A better understanding of factors that influence the selection of RA therapies and comparative effectiveness between therapies is warranted. The objectives of this study were to describe physicians’ and patients’ preferences in selecting specific biologics and comparing clinical response using patient reported outcomes (PROs) among RA patients started on different anti-TNF therapies.

Methods: Eligible patients for this analysis were enrollees in Kaiser Permanente Northern California. RA patients with at least 2 Kaiser visits who started a new anti-TNF therapy from 10/2010 – 8/2011 were initially eligible for participation in a longitudinal telephone survey at baseline (initiation of anti-Tumor Necrosis Factor therapy) and 6 months later. Patients’ preferences in selecting their biologics were collected at baseline. PROs for effectiveness were collected both at baseline and 6 month surveys. Ordinary least squares regression evaluated the change at 6 months across PROs comparing etanercept (ETA) vs. adalimumab (ADA) initiators and controlled for multiple potential confounders.

Results:  There were 384 eligible RA patients available to be contacted; 267 initially responded and 242 initiated etanercept or adalimumab and 187 completed both the baseline and 6 month follow-up telephone surveys. Mean age was 54.4 (SD ± 12.1) and 73.4% were females. A total of 56% of patients self-reported that they were involved in the selection of their specific biologic. The majority of patients (57%) preferred an injectable biologic, 22% preferred an infused biologic, and 21% had no preference. Preferences for injection biologics were mainly motivated by convenience (92%); those preferring infusion therapy were motivated by dislike or lack of self-efficacy for self-injection (15.7%). After 6 months of treatment with anti-TNF biologics, 44% of the patients reported a level of burning and stinging with injection of ≤ 4 in a scale of 0-10 with the last biologic dose, 30% experienced a level > 5 and 26% reported no burning and stinging. RAPID 3, MDHAQ and physical function via the SF12 were significantly better at 6 months without significant difference between ETA or ADA initiators (Table).

Conclusion: Convenience, fears of self-injection and self-efficacy for self-injection were important aspects to patients when selecting an individual therapy. There were clinically small and non-significant differences in effectiveness at 6 months of etanercept versus adalimumab across several PROs.

	Etanercept (N = 118)	Adalimumab (N = 69)
	All initiators	All initiators
RAPID3      Baseline (mean, SD)      Mean difference at 6 months      Adjusted mean difference at 6m*	16.6 (5.7) -6.6 (7.1) Referent	15.9 (5.9) -3.6 (5.5) 2.2 (-0.31, 4.71)**
MDHAQ      Baseline (mean, SD)      Mean difference at 6 months      Adjusted mean difference at 6m*	3.6 (2.0) -1.3 (1.8) Referent	3.6 (2.0) -0.8 (1.6) 0.5 (-0.11, 1.13)**
SF12_PCS      Baseline (mean, SD)      Mean difference at 6 months      Adjusted mean difference at 6m*	30.5 (10.2) 6.0 (12.6) referent	31.2 (10.6) 1.8 (9.5) -2.2 (-6.96, 2.65)**
SF12_ MCS      Baseline (mean, SD)      Mean difference at 6 months      Adjusted mean difference at 6m*	44.3 (12.8) 5.9 (13.3) referent	46.1 (13.1) 4.8 (12.4) 0.05  (-4.54, 4.64)**

RAPID3 = Routine assessment of patient index data 3; MDHAQ = Multidimensional health assessment questionnaire; SF12_mcs/pcs = Short form-12 item survey mental composite scale/physical composite scale; SD = standard deviation. *Controlling for age, gender, RA duration and baseline PRO. **Data shown as Beta coefficients and 95% confidence interval.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-influencing-selection-of-biologic-therapy-and-comparative-effectiveness-in-patient-reported-outcomes-among-patients-with-rheumatoid-arthritis/