Background/Purpose:

The ACR treat-to-target approach for rheumatoid arthritis (RA) recommends regular assessments of disease activity and adjustment of medication regimen until efficacy goals are met. Given recent advances in pharmacologic therapy, this study assessed recent treatment patterns in RA patients (pts) who had newly initiated a DMARD.

Methods:

Adult pts with ≥2 claims for RA, initiating first DMARD between 1/2012–9/2016 (index date; ID) were identified in fully-adjudicated commercial medical and pharmacy health insurance claims, including self-insured, full-risk, and Medicare policies for approximately 40 million lives annually. Those with 12-months continuous enrollment pre- and post-ID and without DMARD claims 12 months pre-ID were selected. Initial utilization of conventional synthetic DMARDs (csDMARDs), TNF inhibitors (TNFi), anti-IL6 pathway antibodies, other biologic DMARDs (bDMARDs), and JAK inhibitors (JAKi), as monotherapy and in combination with csDMARDs, was summarized with descriptive statistics.  Median therapy duration was assessed with Kaplan-Meier method.  End of treatment was defined as drug discontinuation, switch to a new therapy, or addition of another DMARD.

Results:

Among 26,808 identified pts (74.2% female; mean age 51.9±11.0 yrs), 97.7% of pts initiated monotherapy and 2.3% started combination therapies. The most commonly-prescribed monotherapies were csDMARD (91.3%) and TNFi (6.6%). The most commonly-prescribed treatments in combination with csDMARDs included TNFi (88.0%) and other bDMARDs (7.3%). The median duration of csDMARD monotherapy was 230 days. The median treatment duration (combination vs monotherapy) was: 225 vs. 206 days (TNFi), 227 vs. 203 days (anti-IL6), 198 vs. 182 days (other bDMARDs), and 347 vs. 301 days (JAKi). JAKi treatment had the longest therapy duration when combined with csDMARDs (347 days), and other therapies lasted for a median of 182-230 days. As monotherapy, JAKi duration was 301 days, and other therapies lasted for a median of 198-227 days.

Conclusion:

Real-world data from US longitudinal healthcare claims showed that in RA pts newly initiating DMARDs, the median duration of therapy was less than a year, suggesting a need for a treatment with improved response durability. Duration of JAKi therapy was longer than median duration of other therapies. Further research is needed to determine the reasons for the longer persistence of JAKi therapy and why persistence is low with RA therapies overall.