Background/Purpose: Patients with RA are often treated with anti-tumor necrosis factor (TNF) agents. However, patients with a stable response to anti-TNF therapy may discontinue or switch treatments for non-medical reasons such as cost reduction. We evaluated real-world clinical outcomes associated with non-medical switching of anti-TNF therapies among patients with RA in the USA.

Methods: A rheumatologist-administered chart review collected online data (from 1/2011 through 4/2014) on patients with a diagnosis of RA who had a physician-reported stable response to an anti-TNF therapy for ≥6 months (baseline period). Patients who maintained response and either discontinued or switched for non-medical reasons from the anti-TNF (discontinuers) were matched to a patient visiting the same rheumatologist within a 60 day period who did not switch/discontinue therapy for non-medical reasons (continuers). Non-medical reasons for switching/discontinuing therapy included increased copay, change of insurance, job loss, or other economic factors that limited affordability of medication. Switchers/discontinuers were followed for 12 months from the date of discontinuation; continuers were followed for 12 months from the date of an office visit within 2 months of a matched switcher/discontinuer’s discontinuation date. Differences between cohorts in baseline sociodemographic characteristics, disease severity (categorized as mild, moderate, or severe), comorbidities, medication use (anti-TNF and other RA-related drugs), and resource utilization were assessed with descriptive statistics. Generalized linear models were used to compare disease flares, disease control, and use of medical services between groups during the follow-up period, after adjustment for baseline characteristics.

Results: 83 matched pairs of switchers/discontinuers (69.9% switchers/30.1% discontinuers) and continuers were analyzed (N=166). Switchers/discontinuers were more likely than continuers to be Hispanic (27.7% vs 15.7%, P=.041); otherwise, there were no significant differences between cohorts in baseline sociodemographic and disease characteristics, comorbidities, medication use, or resource utilization. In the follow-up period approximately 48% of switchers/discontinuers had well-controlled disease symptoms as assessed by the rheumatologist, a significantly lower rate (adjusted odds ratio=0.15, P<.001) than continuers (84%). Compared with continuers, switchers/discontinuers had a significantly greater risk of flares and more frequent flares across all disease severity levels; they also had an increased risk of emergency department visits and more repeat emergency department visits (both P<.05; Table).

Conclusion: In this real-world study of patients with RA, discontinuation of an anti-TNF therapy for non-medical reasons was associated with significantly worse clinical outcomes and increased health care resource use.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-associated-with-non-medical-switchingdiscontinuation-of-anti-tnf-inhibitors-among-patients-with-rheumatoid-arthritis/