Background/Purpose: During the COVID-19 pandemic, guidelines were amended with respect to the prescribing of biologic/tsDMARD usage to treat rheumatoid arthritis (RA). In addition, regulatory reviews also ensued gauging the safety & risk parameters of Janus kinase inhibitor (JAKi) usage. The purpose of this study was to analyse any biologic/tsDMARD prescribing shifts in RA during this time, and any possible impacts.

Methods: A multi-country, multi-centre, online, medical chart review study of patients with RA was conducted across January – December 2021 (“2021 cohort”) and January – December 2022 (“2022 cohort”), among UK, FR, DE, IT & ES rheumatologists in hospitals and private practices were recruited to collect de-identified data on patients who were recently treated with an advanced therapy (biologic/tsDMARD) as part of their usual care. Physicians were screened for practice duration and patient volume. Rheumatologists abstracted current patient treatment, reasons for prescribing treatments and patient disease score information; patient charts are included in the analysis.

Results: The 2021 cohort consists of 383 sampled physicians who reported on 4999 patients in total. The 2022 cohort consists of 422 sampled physicians who reported on 5161 patients in total.

2022 cohort recorded an increase in biosimilar tumour necrosis factor inhibitor (TNFi) usage among reported patients vs 2021 cohort (31% vs 27%). Alternate available mechanisms of action (MoA) to TNFi recorded a decrease in use to 44% (2022) from 46% (2021) among reported patients; JAKi class share showed minimal change from 24% (2021) to 23% (2022).

In reasons for therapy choice cited by the sampled rheumatologists, the % of reported patients with the following driving metrics have increased from 2021 to 2022: cost/insurance (16% vs 19%), patient request (9% vs 12%), long-term efficacy data available (27% vs 31%) and long-term safety data available (26% vs 29%).

Recorded remission status has decreased from 59% in 2021 cohort to 56% in 2022 cohort.

Conclusion: Comparing the two cohorts in this study data has allowed insight into possible prescribing changes that were beginning to come into view throughout the COVID-19 pandemic and while JAKi regulatory reviews were ongoing: increased prescribing of biosimilar TNFis and decreased prescribing of alternate MoAs. The data shows an increasing desire for long-term safety and efficacy data, patient request, and cost/insurance when physicians are choosing the therapy that their patient is going to be treated with. Interestingly, while the prescribing behaviour of sampled physicians has shifted, disease outcomes of reported patients are not necessarily improving. With patients in this study recording lower remission rates, it may be that the treatment shift away from newer MoA therapies are having an influence. It will be critical to monitor the RA treatment landscape for patient outcomes going forward. Further analysis using comparator cohort is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/review-of-rheumatoid-arthritis-treatment-landscape-during-the-covid-19-pandemic/