Background/Purpose:  Infliximab (IFX) and golimumab (GLM-IV) for intravenous use are anti-TNF agents indicated for rheumatoid arthritis (RA) and differ in weight-based dose, induction schedule, and infusion time. Few real-world GLM-IV utilization studies exist, and none compare GLM-IV to IFX utilization in the same patient (pt) population. To describe pt characteristics and utilization patterns in IFX-treated RA pts later treated with GLM-IV.

Methods:  A large US health claims database was used for a retrospective analysis. Pts had ≥ 1 RA diagnosis (ICD-9 CM;714.0), ≥ 6 months continuous enrollment before IFX initiation and ≥ 1 GLM-IV claim after IFX discontinuation. Pts < age 18 years or with pregnancy were excluded. The IFX index date was defined as the 1^st IFX infusion of the most recent IFX episode before GLM-IV initiation. GLM index was the date of first GLM-IV claim between 1/1/2014 and 6/30/2015. Patient characteristics, Claims-based Index for Rheumatoid Arthritis Severity (CIRAS), average vials per infusion (VPI), infusion interval and billed infusion time were studied over a variable length follow up. IFX or GLM VPI were estimated by dividing paid cost by drug wholesale acquisition cost. Infusion time was estimated by the proportion of claims with 2^nd hour infusion codes (CPT- 96415 or 96366). Where appropriate, claims associated with $0 cost were removed from the analysis.

Results:  A total of 188 IFX patients who transitioned to GLM-IV were identified. At the IFX index date, the population was 78% female; mean age was 56 years; 79% were commercially insured. The average time between end of IFX and GLM-IV index was 419 days (d); 86% of pts received GLM-IV as their next anti-TNF after IFX. Mean CIRAS was 5.4 at IFX and GLM-IV index dates. Concomitant methotrexate was used in 30% of IFX and 25% of GLM-IV pts. The mean (SD) duration of IFX was 512 (554) d. During IFX treatment, 2,176 IFX infusions were administered. Mean (median) number of infusions per pt were 12 (8) and median VPI was 5. The majority of IFX infusions (97%) had at least one 2nd hour infusion code. The average time between maintenance infusions was 51 d; 40% were 7 to 9 weeks apart. The mean (SD) observation period for GLM-IV treatment was 151 (142) d; the majority (66%) appeared to remain on therapy (censored) at end of data availability. During the observation period, 734 GLM-IV infusions were administered. Pts received a mean of 4 GLM-IV infusions during observation; 36% of pts received 5 or more infusions. Few (2%) GLM-IV infusions had a 2^nd hour infusion code. Median GLM-IV VPI was 4. The average time between GLM-IV maintenance infusions was 57 days; 82% were 7 to 9 weeks apart.

Conclusion: This retrospective analysis describes pt characteristics and medication utilization for IFX-treated RA pts who later used GLM-IV. On average, GLM-IV was associated with lower VPI, greater consistency in dosing patterns (proportion of maintenance infusion intervals every 7 to 9 weeks) and better administration time efficiency as evidenced by a lower proportion of claims for a second hour infusion billing code. These findings may be relevant for healthcare decision-makers interested in understanding potential variation in healthcare delivery.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-characteristics-and-medication-utilization-patterns-of-infliximab-treated-rheumatoid-arthritis-patients-subsequently-transitioned-to-intravenous-golimumab/