Background/Purpose: A majority of RA patients who switch from a tumor necrosis factor inhibitor (TNFi) to another biologic disease-modifying anti-rheumatic drug (DMARD) are TNFi cyclers (Bonafede M et al. Adv Ther 2012;29:664-74). The objective of this study was to examine subsequent biologic switching among RA patients in a large US managed care population after they switched between two TNFi (“TNFi cyclers”), between a TNFi and a non-TNFi, or between two non-TNFi.

Methods: Index claims from January 2010 to June 2014 were analyzed from the Truven Health MarketScan^® Commercial database. The “index claim” was the first claim for a biologic DMARD or tofacitinib. Patients were required to be ages 18-64 years at index with ≥12 months of continuous medical and pharmacy enrollment pre- and post-index, ≥1 claim for RA (ICD-9-CM 714.0x) at baseline (pre-index) or within 30 days post-index, ≥1 claim for a different biologic at baseline, no claim for the index agent at baseline, and no claim for any other autoimmune condition. Patients who switched therapy again within 6 months or within 12 months after the index date were categorized based on baseline and index therapy.

Results: Of the 7304 patients who met the selection criteria, 82.1% were female. Mean age was 50.1 years (SD=9.5) and mean Deyo Charlson Comorbidity Index Score was 1.4 (SD=0.9). A total of 4764 (65.2%) patients were TNFi cyclers, 1826 (25.0%) switched from a baseline TNFi to an index non-TNFi, 418 (5.7%) switched from a baseline non-TNFi to an index TNFi, and 296 (4.1%) switched from a baseline non-TNFi to an index non-TNFi. Mean age at index was similar across cohorts (49.5 to 51.9 years); 80.9% to 84.5% of patients in each cohort were female. The table summarizes the proportion of patients who switched therapy again in the first 6 or 12 months post-index. For patients who switched from a baseline TNFi to an index non-TNFi, compared with TNFi cyclers, the odds ratio for switching therapy again was 0.619 (95% CI: 0.53, 0.72; p<0.01) within 6 months and 0.824 (95% CI: 0.73, 0.93; p<0.01) within 12 months.

Conclusion: RA patients who switch biologic therapy frequently switch again within 12 months. Compared with patients who switch between two TNFi (TNFi cyclers), patients who switch from a TNFi to a non-TNFi are less likely to switch therapy again within 6 or 12 months.

Jonathan Latham of PharmaScribe, LLC provided medical writing assistance.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-ra-biologic-switching-and-cycling-in-a-large-us-managed-care-population/