Background/Purpose: US rheumatologists have long agreed that methotrexate (MTX) is the backbone of rheumatoid arthritis (RA) treatment, and while comfort with biologic/JAK monotherapy is growing, the majority of RA patients remain on a combination regimen, either with MTX or another conventional DMARD. With IL-6 inhibiting biologics and JAKs touted for their efficacy as monotherapy treatment options, this research sought to understand physician’s attitudes towards combination therapy and the role monotherapy plays as a driver behind brand choice when switching RA patients from one biologic/JAK to another.

Methods: An independent market analytics firm collaborated with US rheumatologists (n=320) to conduct a retrospective chart review of patients diagnosed with rheumatoid arthritis (RA) (n=1,312), who had switched from one biologic/JAK therapy to another in the prior twelve weeks.  Rheumatologists were able to submit up to seven RA patient charts. Data were collected in September 2018 and included clinical and non-clinical patient demographics, as well as physician demographics and attitudinal survey responses.  This study was a non-longitudinal trending analysis to 2016 and 2017 audits following the same methodology.

Results: Approximately two-thirds of collaborating US rheumatologists agree with the statements: “MTX is the backbone of RA treatment” and “I prefer to prescribe biologics in combination with MTX whenever possible;” however, three-quarters also agree, “my comfort in using biologics/JAK monotherapy is growing.”  Indeed, when examining the chart audits of recently switched RA patients, only 35% were on a true monotherapy regimen (no MTX, other conventional DMARDs, or steroids), a figure that has remained stable since 2016.  Half of all recently switched, biologic/JAK-treated RA patients were on a combination regimen with MTX, and there were no significant differences in rates of combination MTX use by RA disease severity.  The possibility of biologic/JAK monotherapy was significantly more of a driver behind the decision to switch patients to JAK and IL-6 inhibitors than it was for switches to TNF-α inhibitors, abatacept, or rituximab. However, patients recently switched to a TNF were just as likely as those switched to a JAK, and more likely than those switched to an IL-6, to be on a monotherapy regimen.   

Conclusion: While US rheumatologists state they are becoming more comfortable with biologic/JAK monotherapy for the treatment of RA, use of biologic/JAK therapy in combination with a conventional DMARD (most commonly MTX), is common practice and has not changed since 2016. The possibility of monotherapy treatment is a factor in the decision to switch patients to JAK and IL-6 inhibitors more commonly than when switching to other biologic classes; however, there are no statistically significant differences in rates of monotherapy by mechanism of action among recently switched RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-and-influence-of-biologic-janus-kinase-monotherapy-among-recently-switched-rheumatoid-arthritis-patients-results-from-an-annual-national-patient-chart-audit/