Background/Purpose:  Immune-mediated rheumatic disease (IMRD) including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), are severe and disabling chronic diseases in rheumatology. Biotherapies such as subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) have transformed the management of rheumatoïd diseases. Very few studies have assessed the persistence to all four SC- TNFis for IMRD in a European setting. The objective of this study was to describe treatment persistence in a real-world setting, among patients diagnosed with IRMD, initiating treatment with an SC-TNFi in France and who were naïve of biotherapies (subcutaneous and intravenous) in the last 18 months.

Methods: The Système National d’Information Inter-régime [French national health insurance scheme information-sharing system] (SNIIR-AM) database lists all outpatient and inpatient healthcare consumption for individuals covered by the general health insurance scheme. Using French claims data, patients were included through Long Term Disease (LTD) status and hospital admission, based on ICD-10 codes. Identification of RA was based on M05, M06, M08.0, M08.2, M08.4 and M13 ICD-10 codes. For AS, identification was based on M08.1, M08.8, M08.9, M45 and M46 to M14 ICD-10 codes, and identification of PsA was based on M07 and M09 ICD-10 codes. Patients were then identified through filled prescription for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP) and golimumab (GLM) between 06/01/2012 and 12/31/2013. Persistence was estimated using Kaplan Meier analysis.

Results:  A total of 4,750 patients with RA were identified, 5,735 with AS and 1,244 with PsA. For the overall cohort of IMRD naïves patients, comparisons over 12 months showed that persistence was different between the four SC-TNFis, with persistence rates of 59.1% for CZP, 56.4% for ETA, 57.2% for ADA and 60.2% for GLM (p=0.0004). For RA cohort (p<0.0983) persistence rates were 60.3% for CMZ, 60.9% for ETA, 62.2 % for ADA and 63.8% for GLM. For AS (p<0.0001) persistence rates were 52.7% for ETA, 54.6% for ADA and 58.9 % for GLM. For PsA, persistence rates were 52.5% for ETA, 57.8% for ADA and 55.9 % for GLM (p=0.2014). For AS and PsA analysis sample size of CMZ cohort were too small to estimate Kaplan-Meier curves.

Conclusion:  Persistence rates observed in naïves patients varied according to SC-TNFis with significant difference for the overall and the AS cohorts. Those results seem correspond with others results published recently in the literature

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-persistence-with-subcutaneous-tnf-alpha-inhibitors-in-france/