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Abstract Number: 252

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

Aliza Karpes 1, Zhigang Duan 2, Hui Zhao 2, Lincy Lal 3, Wenyaw Chan 3, Maria E. Suárez-Almazor 4, Sharon Giordano 2, John Swint 3 and Maria Lopez-Olivo2, 1School of Public Health, The University of Texas Health Science Center at Houston, Dallas, TX, 2The University of Texas, MD Anderson Cancer Center, Houston, TX, 3School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 4Department of Rheumatology/Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX , USA., Houston, TX

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: costs, Rheumatoid arthritis (RA), treatment options and TNFi failure

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Session Information

Date: Sunday, November 10, 2019

Session Title: Health Services Research Poster I – ACR/ARP

Session Type: Poster Session (Sunday)

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

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.


Disclosure: A. Karpes, None; Z. Duan, None; H. Zhao, None; L. Lal, None; W. Chan, None; M. Suárez-Almazor, Bristol-Myers Squibb, 5, Pfizer Inc, 5, Eli Lilly, 5; S. Giordano, None; J. Swint, None; M. Lopez-Olivo, None.

To cite this abstract in AMA style:

Karpes A, Duan Z, Zhao H, Lal L, Chan W, Suárez-Almazor M, Giordano S, Swint J, Lopez-Olivo M. 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 [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). 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/. Accessed April 11, 2021.
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