Background/Purpose: To evaluate the sequences of therapeutic drugs used by rheumatoid arthritis (RA) patients whose initial tumor necrosis factor inhibitor (TNFi) therapy failed, as well as mean time to therapy discontinuation and costs of TNFi and non-TNFi drugs.

Methods: Using the IBM MarketScan Research Databases, we analyzed claims of adult RA patients who switched to their second biological or targeted disease-modifying antirheumatic drug between January 2008 and December 2015. We determined the most common treatment sequences and estimated the time to therapy discontinuation. We compared drug and other health care costs between adherent and non-adherent patients.

Results: Among 10,442 RA patients identified, 36.5% swapped to a non-TNFi drug, most commonly (54.2%) abatacept. The remaining 63.5% switched to a cycling regimen (second TNFi), most commonly adalimumab (41.2%). For subsequent lines of therapy, non-TNFi drugs were more common. Patients who swapped were significantly older and sicker than those who cycled (p < 0.001). Survival analysis showed a longer time to discontinuation for second-line non-TNFi drugs than for TNFi (median 471 days compared with 370 days, p < 0.001), but no difference in subsequent lines of therapy. Although non-TNFi drugs were less expensive for adherent patients, cycling was associated with lower costs overall.

Conclusion: Although patients are more likely to cycle to a second TNFi than swap, those who swap to a non-TNFi drug are more likely to persist with the second-line therapy. However, cycling appears to be the less costly strategy.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-sequences-effectiveness-and-costs-of-tumor-necrosis-factor-inhibitor-cycling-compared-with-swapping-to-a-novel-disease-modifying-anti-rheumatic-drug-in-rheumatoid-arthritis-patients/