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Abstract Number: 1145

Evaluation of Biologic Treatment Patterns, Clinical Outcomes, and Healthcare Resource Utilization Post-Tumor Necrosis Factor Inhibitor Discontinuation in Rheumatoid Arthritis

J. Harnett1, D. Wiederkehr1, R. Gerber2, D. Gruben2, A. Koenig3 and J. Bourret3, 1Pfizer Inc, New York, NY, 2Pfizer Inc, Groton, CT, 3Pfizer Inc, Collegeville, PA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Biologics, Health Care, rheumatoid arthritis, treatment and tumor necrosis factor (TNF)

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Session Information

Session Title: Health Services Research

Session Type: Abstract Submissions (ACR)

Background/Purpose: For rheumatoid arthritis (RA) patients (pts) with inadequate response to a TNF inhibitor (TNFi), limited evidence exists from observational studies and indirect comparisons of randomized trials to support switching to a nonTNFi vs another TNFi. These exploratory analyses evaluate clinical outcomes and healthcare resource use (HCRU) after switching from a TNFi to another TNFi or nonTNFi biologic across 2 de-identified real world data sources.

Methods: Pts (≥18 years) with ≥2 outpatient or 1 inpatient visit for RA (ICD-9: 714.xx) and (1) HCP-reported TNFi discontinuation and switch to a biologic or conventional DMARD (cDMARD) within 180 days in Humedica EHR database (1/07-7/13) or (2) switched from TNFi to another biologic (or 1 pt to tofacitinib) in Truven Marketscan® claims database (2010-2013) were included. Pts had continuous enrollment/follow-up ≥6 months (mo) before and ≥12 (claims) or 18 (EHR) mo after discontinuation. EHR cohort was followed for 18-mo all-cause HCRU and change in patient-reported pain scores (0-10 on provider-determined scales; ≥30 days pre-/post-switch). Claims cohort was evaluated for subsequent biologic switching and RA-related HCRU costs. Multivariable analyses evaluated the impact of switching to a TNFi vs nonTNFi on RA‑related costs.

Results: Of 2799 pts who discontinued a TNFi (47% etanercept, 28% adalimumab, 21% infliximab, 4% other) in the EHR cohort, reasons were lack of efficacy (14%), AE/other clinical reason (16%), cost (6%), or unknown (65%). Following discontinuation, 21% switched to another biologic (67% TNFi) and 11% to cDMARD. In the claims cohort, 68% switched to another TNFi, of whom 43% switched again vs 28% of those first switched to a nonTNFi biologic. Among EHR pts with pre-/post-switch pain scores, TNFi (n=58), nonTNFi biologic (n=19), or cDMARD (n=55) switchers had mean (standard deviation [SD]) pain reductions of 0.72 (3.12), 1.11 (2.87), and 0.42 (3.88), respectively. Office visits comprised the largest HCRU category in the 18 mo after switching; mean (SD) number: 42.7 (34.5), 57.6 (47.3), and 38.4 (33.3) for TNFi, nonTNFi, or cDMARD switchers, respectively. Nearly half (n=7.2) the difference in office visits with TNFi vs nonTNFi was associated with biologic administration procedures. Unadjusted mean (SD) RA‑related costs were $27544 ($21100) for TNFi vs $44742 ($30743) for nonTNFi switchers. Including biologic administrations without RA diagnosis (TNFi, $389; nonTNFi, $1126), most (79%) of the mean cost differences were attributed to outpatient visits, followed by prescriptions (18%). Biologic administration visits accounted for 89% of outpatient cost differences. NonTNFi therapy was associated with 32% higher total RA-related costs in adjusted analyses (p<0.0001).

Conclusion: NonTNFi switchers were less likely to switch again and had greater pain reduction vs TNFi switchers (in a small subset). NonTNFi switchers had higher all‑cause HCRU and RA-related costs, largely due to in‑office administration. NonTNFi therapies that do not require in-office administration may reduce switching and costs. Disease outcomes and financial consequences of clinical decision-making warrant future prospective structured research.


Disclosure:

J. Harnett,

Pfizer Inc,

1,

Pfizer Inc,

3;

D. Wiederkehr,

Pfizer Inc,

1,

Pfizer Inc,

3;

R. Gerber,

Pfizer Inc,

1,

Pfizer Inc,

3;

D. Gruben,

Pfizer Inc,

1,

Pfizer Inc,

3;

A. Koenig,

Pfizer Inc,

1,

Pfizer Inc,

3;

J. Bourret,

Pfizer Inc,

1,

Pfizer Inc,

3.

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