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Abstract Number: 555

Outcomes Associated with Non-Medical Switching/Discontinuation of Anti-TNF Inhibitors Among Patients with Rheumatoid Arthritis

Douglas C. Wolf1, Martha Skup2, Hongbo Yang3, Elizabeth Faust3, Jenny Griffith2, Jingdong Chao2 and Mark Lebwohl4, 1Atlanta Gastroenterology Associates, Atlanta, GA, 2AbbVie Inc., North Chicago, IL, 3Analysis Group, Inc., Boston, MA, 4Mount Sinai Medical Center, New York, NY

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: anti-TNF therapy, Economics, Health care cost and rheumatoid arthritis (RA)

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Session Information

Date: Sunday, November 8, 2015

Session Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

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.

 

Table. Treatment Response and Health Care Resource Utilization Among Patients with RA

 

Odds Ratio/Incidence Rate Ratio

(Anti-TNF Switchers/Discontinuers vs Continuersa)

Unadjusted

P-value

Adjusted

P-value

Likelihood of ≥1 Flare

3.29

<.001*

3.63

<.001*

Mild RAb

1.90

.018*

2.26

.005*

Moderate RAb

5.78

<.001*

5.76

<.001*

Severe RAb

2.83

.013*

2.88

.018*

Number of Flares

1.63

.041*

3.73

<.001*

Mild RAb

1.53

.016*

2.51

<.001*

Moderate RAb

1.68

.110

5.83

<.001*

Severe RAb

1.88

.128

10.10

<.001*

Likelihood of ≥1 urgent care visitc

3.02

.039*

6.05

.024*

Likelihood of ≥1 inpatient stay

2.05

.325

3.87

.185

Likelihood of ≥1 ED visit

4.32

.046*

6.94

.022*

Number of ED visits

8.00

.015*

9.85

.008*

Number of outpatient visitsd

1.13

.119

1.09

.199

*P-value <.05.

aNon-medical reasons for switching/discontinuing anti-TNF therapy included increased copay, switching of insurance, job loss, or other economic factors that limited affordability of medication.

bMild, moderate, and severe disease, based on physician opinion.

cUrgent care was defined as inpatient stays or ED visits.

dPatients were required to have ≥1 outpatient visit in the study period.

ED, emergency department.


Disclosure: D. C. Wolf, AbbVie, 2,AbbVie, 5,AbbVie, 8; M. Skup, AbbVie, 1,AbbVie, 3; H. Yang, Analysis Group, which received payment from AbbVie to participate in this research, 3; E. Faust, Analysis Group, which received payment from AbbVie to participate in this research, 3; J. Griffith, AbbVie, Inc., 1,AbbVie, Inc., 3; J. Chao, AbbVie, 1,AbbVie, 3; M. Lebwohl, AbGenomics, Amgen, Anacor, Canfite Biopharma, Celgene, Clinuvel, Coronado Biosciences, Dermipsor, Ferndale, Lilly, Janssen Biotech, LEO Pharmaceuticals, Merz, Novartis, and Pfizer, 9.

To cite this abstract in AMA style:

Wolf DC, Skup M, Yang H, Faust E, Griffith J, Chao J, Lebwohl M. Outcomes Associated with Non-Medical Switching/Discontinuation of Anti-TNF Inhibitors Among Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/outcomes-associated-with-non-medical-switchingdiscontinuation-of-anti-tnf-inhibitors-among-patients-with-rheumatoid-arthritis/. Accessed April 13, 2021.
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