Background/Purpose: The purpose of our study is to investigate the difference in time to access of rituximab therapy between patients with rheumatoid arthritis (RA) compared to patients with other autoimmune diseases.

Methods: A retrospective chart review was performed on 236 patients under the care of rheumatologists out of the University of Alberta, who had received rituximab from October 2012 to October 2017. Data extracted included the method of drug coverage, the date determining when a patient would require rituximab for treatment and the date of first infusion. A Cuzick’s test of trend was performed on three groups. The first group includes patients with autoimmune disease (not RA) receiving coverage through the Short Term Exceptional Drug Therapy (STEDT) program, Alberta’s publicly funded special access program for high cost drugs. The second group includes patients with autoimmune disease (not RA) who receive non-STEDT funding, encompassing compassionate care and insurance. The third group includes RA patients followed by the Rheumatoid Arthritis Pharmacovigilance Program and Outcomes Research in New Therapies (RAPPORT) clinic at the University of Alberta whom all receive non-STEDT funding. Analysis was conducted using STATA 13.

Results: Of the 236 patients, 154 patients were identified as having RA and followed by the RAPPORT clinic. Eighty-two patients were identified as having other autoimmune diseases (vasculitis, dermatomyositis, systemic lupus erythematosus, myositis, sarcoidosis, Sjogren’s and ankylosing spondylitis). Of these 82 patients, 54 had their rituximab covered through Alberta’s STEDT program and 28 patients received coverage from non-STEDT programs. The median time to access was 36 days (QR: 25, 53) for RAPPORT patients, 30 days (QR: 17, 44) for STEDT patients with other autoimmune diseases and 45.5 days (QR: 33, 63) for non-STEDT patients with other autoimmune diseases. The Cuzick’s test revealed a statistically significant trend between groups (p-value = 0.004).

Conclusion: Our analysis concludes that public funding through the STEDT program, allows quicker access to rituximab compared to alternative sources of funding including compassionate care and insurance. RA patients who also receive non-STEDT coverage also receive rituximab more quickly, having the benefit of a dedicated clinic familiar with drug application processes. The result of this study indicates evidence of medication health economic disparity between access for patients with different conditions. This is concerning for patients who require medications quickly, for disease control, such as vasculitis patients, who appear to have less equity in access to rituximab. Further analysis is necessary to determine causes for this disparity and expedite access.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-equity-access-to-rituximab-for-patients-comparing-variable-access-in-a-single-rheumatology-clinic/