Risk of Hospitalization Among RA Patients with Multiple Autoimmune Co-Morbidities Differs By DMARD Treatment

E Alemao, Z Guo and L Burns, Bristol-Myers Squibb, Princeton, NJ

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: autoimmune diseases and rheumatoid arthritis (RA)

Session Information

Date: Monday, November 6, 2017

Title: Health Services Research Poster II: Osteoarthritis and Rheumatoid Arthritis

Session Type: ACR Poster Session B

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

Background/Purpose: Patients (pts) with autoimmune (AI) disorders are at higher risk of developing another AI disorder; co-occurrence of some AI conditions is reported more frequently than others in RA pts.¹The objective was to evaluate 6- and 12-month (mo) hospitalization rates in RA pts with multiple AI co-morbidities, treated with abatacept, biologic (b) or conventional (c)DMARDs. Methods: Administrative claims data from Optum Clinformatics Data Mart (database A) and QuintilesIMS^TM PharMetrics Plus (database B) from 2006 to 2015 were used. Inclusion was based on the presence of 2 diagnosis codes for RA plus 1 DMARD prescription, age ≥18 yrs, ≥1 of the 5 most prevalent AI conditions: ankylosing spondylitis (AS), Crohn’s disease, lupus, psoriasis or ulcerative colitis at or before index, ≥3 mo baseline (pre-index date) and 3 mo of follow-up (post-index date). Mutually exclusive treatment groups were classified based on the index prescription using hierarchy of abatacept, other bDMARD and cDMARD. Also, an RA group without record of DMARD (NoDMARD) was identified. Date of first DMARD was index date (for NoDMARD, index date was first diagnosis date). Primary outcome was 6- and 12-mo hospitalizations. Treatment groups were compared using descriptive statistics (Wilcoxon rank-sum test for continuous variables or Pearson’s chi-square test for categorical variables) and using multivariate Cox regression analyses for hospitalization risk. Covariates included in the multivariate analysis were age, sex, region, past hospitalization, physician office visits during past 3 mo, an indicator variable for 714.0x, medication use (steroids, NSAIDs, salicylates, antidyslipidemics), the 5 AI and 18 co-morbidity conditions. Results: A total of 18,964 and 47,105 RA pts with multiple AI co-morbidities from databases A and B, respectively, were included. The mean (SD) age of study population was 55.4 (15.1) yrs in database A and 50.0 (13.0) in database B. Respectively, 4.4%, 20.7%, 41.6% and 33.3% were prescribed abatacept, bDMARD, cDMARD and NoDMARD in database A; and 3.7%, 25.9%, 40.5% and 29.8% in database B. The most common AI co-morbidities in databases A vs B were AS (29 vs 27%), lupus (32 vs 32%) and psoriasis (32 vs 34%). Abatacept-treated pts had higher past hospitalization rates vs bDMARD and cDMARD groups. 6- and 12-mo pooled adjusted hazard ratios for hospitalization were higher for bDMARDs (and cDMARDs) vs abatacept (Table). Results were consistent in both databases.

Conclusion: Among RA pts with multiple AI co-morbidities, adjusted risk of hospitalization in both bDMARD- and cDMARD-treated pts was significantly higher compared with abatacept-treated pts. Though the NoDMARD group had an even higher risk of hospitalization, this should be interpreted with caution as it comprises a heterogeneous pt population

1. Cooper GS, et al. J Autoimmunity 2009;3:197–207.

Disclosure: E. Alemao, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3; Z. Guo, Bristol-Myers Squibb, 3; L. Burns, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3.

To cite this abstract in AMA style:

Alemao E, Guo Z, Burns L. Risk of Hospitalization Among RA Patients with Multiple Autoimmune Co-Morbidities Differs By DMARD Treatment [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/risk-of-hospitalization-among-ra-patients-with-multiple-autoimmune-co-morbidities-differs-by-dmard-treatment/. Accessed .

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