Background/Purpose: A fixed treatment paradigm often exists for Rheumatoid Arthritis(RA) patient(pts)¹. However, RA is a heterogeneous disease and differences in pts’ serostatus affect disease progression. For pts receiving targeted disease modifying antirheumatic drug (tDMARD) (biologics and JAK inhibitors), this study compares the differences in treatment factors such as persistence, adherence and medication effectiveness for pts with versus those without poor prognostics factors (PPF).

Methods: Pts ≥18 years and satisfying either ACR 1987 or 2010 criteria in the JointMan database between 1 Jan 2009 and 31 Mar 2017 were included. Pts were required to have at least one record for either anti-citrullinated protein antibodies(ACPA) or rheumatoid factor (RF) at baseline (study period start date to index treatment initiation + 30 days). Pts who were ACPA positive (+) only, RF+ only or dual+ were considered PPF positive (PPF+) and pts who were both ACPA and RF negative (-) were controls (PPF-). First tDMARD prescription date was considered as the index date.

Persistence, measured as number of days from index date to first switch from, or discontinuation of the index tDMARD or end of study period, whichever came first, was reported for the two cohorts. Persistence was stratified by cohort and PPF+ subgroups. Kruskal-Wallis test compared median persistence with a significance level of 0.05. Comparisons for all treatment factors will be conducted in the same way.

Results: 797(71 %) out of the 1,122 pts included in the analysis were PPF+. Compared to controls, PPF+ pts were older (59 vs 56 yrs) and less likely to be females (73 vs 81%). Overall, median persistence was greater for the PPF+ cohort (420 vs 379 days) but not significant. Comparison of the PPF+ subgroups to controls showed significant differences in persistence between ACPA+ and dual+ pts versus controls. Intragroup comparison of PPF+ subgroups also showed that dual+ pts had substantially lower persistence compared to ACPA+ and RF+ subgroups. ACPA+ pts remained on tDMARD therapy the longest. (ACPA+: 577, RF+: 484, dual+: 344 days)

Table1: Persistence (days) by subgroups of PPF

Conclusion:

In this study, tDMARD persistence varied based on PPF status. Scientific evidence also demonstrates a correlation between serostatus and RA disease progression. PPF status may need to be considered in tDMARD assignment decisions. Further analysis to evaluate the effect of PPF status on other treatment factors is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-poor-prognostic-factors-with-medication-persistence-among-adult-ra-patients-within-a-community-of-rheumatology-clinics/