ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2338

Biologic Switching Rates Among Patients With Rheumatoid Arthritis

L Rosenblatt1, F Lobo1, P Cockrum2, L Wang3, E Alemao2, O Baser4 and H Yuce5, 1Bristol-Myers Squibb, Plainsboro, NJ, 2Bristol-Myers Squibb, Princeton, NJ, 3STATinMED Research, Dallas, TX, 4STATinMED Research and University of Michigan, Ann Arbor, MI, 5New York City College of Technology (CUNY), Brooklyn, NJ

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy III

Session Type: Abstract Submissions (ACR)

Background/Purpose: Treatment guidelines for the management of RA recommend sequential use of biologic therapies, and the majority of patients switch from one anti-TNF agent to another. Previous data from commercial claims databases have shown that patients on a second-line anti-TNF agent are more likely to switch biologic treatment than those on second-line abatacept, a biologic with a different mechanism of action.1 We assessed treatment switching in a Medicare population of patients with RA, who had received a first- or second-line biologic DMARD (bDMARD; abatacept, adalimumab, etanercept, infliximab). Methods: A retrospective, observational analysis using Medicare claims data (January 2006–December 2010) was conducted in patients with RA newly initiated on a bDMARD (first-line cohort). Further analysis in a subgroup compared first-line anti-TNF patients who switched to another anti-TNF (adalimumab, etanercept, infliximab) with first-line anti-TNF patients who switched to abatacept (second-line cohort). Patients in the first- and second-line cohorts were required to have a minimum of 6-month pre-index, and 12-month post-index, eligibility. Patients were defined as switchers if they had a claim for a new bDMARD within 200% days’ supply of the last claim for index bDMARD during the post-index period. Switch rates in first- and second-line cohorts were determined. Patients who discontinued index bDMARD (and did not switch) in the post-index period were excluded from the analyses. Logistic regression determined the odds of switching for patients on abatacept compared with those on anti-TNFs, while controlling for covariates. Results: Of the 18,148 first-line bDMARD patients with RA included in the analyses (81.5% anti-TNF and 18.5% abatacept), switch rates were 11.7% and 10.6% for those taking anti-TNFs and abatacept, respectively (p=0.0174). For the second-line analyses, 777 bDMARD patients were included (45.4% anti-TNF and 54.6% abatacept). Subsequent switch to a third bDMARD occurred in 12.7% of those who had previously switched to abatacept and 28.6% of those who had previously switched to an anti-TNF (p<0.001). Logistic regression demonstrated that, after adjusting for covariates, patients who switched to abatacept had significantly lower odds of switching again than anti-TNF switchers (odds ratio=0.33, 95% CI: 0.22, 0.51).  

  Total, n (%) Switchers, n (%)
First-line analysis (n=18,148)    
Anti-TNF 14,794 (81.5) 1728 (11.7)
Abatacept 3354 (18.5) 357 (10.6)
Second-line analysis (n=777)    
Anti-TNF to anti-TNF 353 (45.4) 101 (28.6)
Anti-TNF to abatacept 424 (54.6) 54 (12.7)
  Conclusion: In a Medicare population, patients with RA who switch between anti-TNFs have significantly higher rates of subsequent bDMARD switch compared with those who switch from an anti-TNF to abatacept. It is hypothesized that treatment pathways that include switching to a different class of bDMARD may reduce subsequent overall bDMARD switch rates and therefore reduce costs in the management of patients with RA.   Reference 1. Meissner B, et al. Arthritis Rheum 2011;63(Suppl 10): 2198.

Disclosure:

L. Rosenblatt,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3;

F. Lobo,

Bristol-Myers Squibb,

3;

P. Cockrum,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3;

L. Wang,

Bristol-Myers Squibb,

5;

E. Alemao,

Bristol-Myers Squibb,

3;

O. Baser,

Bristol-Myers Squibb,

5;

H. Yuce,
None.

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