Background/Purpose: The primary goals of treating Ankylosing Spondylitis (AS) patients are to maximize long-term health-related quality of life through control of symptoms and inflammation, prevention of progressive structural damage, and preservation of function. With two classes of biologic disease modifying agent (bDMARD) currently available, providers have more options to offer to their patients, especially after failing a first biologic. The objective of this study was to describe treatment patterns (persistence, discontinuations, and switch to a 2nd or 3rd line biologic) in the 2 years following the initiation of biologic therapy in AS patients.

Methods: Adult patients with ≥ 2 AS diagnoses were included in this retrospective analysis of medical and pharmacy claims data from the Truven MarketScan Commercial Claims database. AS patients who newly initiated a biologic agent (etanercept, adalimumab, golimumab, infliximab, or certolizumab pegol) during the period from January 1, 2009, to December 31, 2013 were selected and indexed on their first biologic during the time period. All patients were required to have a 1-year pre-index clean period of all biologic therapy and continuous enrollment (medical and prescription) 1-year pre-index and 2-years post-index. Patients were excluded if they had ≥2 diagnostic codes for any of the following conditions: Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, Psoriatic Arthritis, Crohn’s Disease, Ulcerative Colitis, Plaque Psoriasis, Hidradenitis Suppurarativa, or Uveitis. Demographic, clinical, and treatment patterns were analyzed. Treatment patterns included switching to a new biologic (2 and 3+ lines), discontinuation (≥90-day gap in therapy), or persistence (no gaps in therapy ≥90-days) during the 2-year follow-up period.

Results: A total of 1,372 AS patients met the inclusion criteria for this study. The majority of patients (61.7%) were male and the overall mean age of patients was 43.8 years. Adalimumab was the index biologic for 44.1% of patients, followed by etanercept (40.9%), infliximab (10.6%), golimumab (4.3%), and certolizumab pegol (0.1%). During the follow-up period, 33.1% of patients (n=454) were persistent on their index biologic, while 66.9% (n=918) either discontinued their index biologic therapy or switched to a 2^nd line biologic. Among the patients who discontinued their first index biologic, 39.1% (n=359) switched to a 2^nd line biologic. Of those with a 2^nd line biologic, 20.1% (n=72) had 3 or more different biologics prescribed during the follow-up period. From 2009 to 2013, the proportion of new biologic users initiating 2^nd line biologic increased over time from 25.2% to 28.8% (average for all four years = 26.2%).

Conclusion: This study suggests that approximately two-thirds of AS patients newly initiating on a biologic do not remain on the index therapy 2 years post initiation. More work is needed to understand the reasons for non-persistence and the increasing trend of second line biologic use in this population.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/persistence-discontinuation-and-switching-patterns-among-ankylosing-spondylitis-patients-newly-initiating-biologic-therapy/