OP0313 COST-EFFECTIVENESS OF A JAK1/JAK2-INHIBITOR VS. A BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG IN A TREAT-TO-TARGET STRATEGY FOR RHEUMATOID ARTHRITIS

Objective.To ascertain whether strategies of treatment with a biological disease-modifying antirheumatic drug (bDMARD) are cost-effective in an English setting. Results are presented for those patients with moderate to severe rheumatoid arthritis (RA) and those with severe RA.Methods.An economic model to assess the cost-effectiveness of 7 bDMARD was developed. A systematic literature review and network metaanalysis was undertaken to establish relative clinical effectiveness. The results were used to populate the model, together with estimates of Health Assessment Questionnaire (HAQ) score following European League Against Rheumatism response; annual costs, and utility, per HAQ band; trajectory of HAQ for patients taking bDMARD; and trajectory of HAQ for patients using nonbiologic therapy (NBT). Results were presented as those associated with the strategy with the median cost-effectiveness. Supplementary analyses were undertaken assessing the change in cost-effectiveness when only patients with the most severe prognoses taking NBT were provided with bDMARD treatment. The costs per quality-adjusted life-year (QALY) values were compared with reported thresholds from the UK National Institute for Health and Care Excellence of £20,000 to £30,000 (US$24,700 to US$37,000).Results.In the primary analyses, the cost per QALY of a bDMARD strategy was £41,600 for patients with severe RA and £51,100 for those with moderate to severe RA. Under the supplementary analyses, the cost per QALY fell to £25,300 for those with severe RA and to £28,500 for those with moderate to severe RA.Conclusion.The cost-effectiveness of bDMARD in RA in England is questionable and only meets current accepted levels in subsets of patients with the worst prognoses.

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THU0555 HEALTHCARE COSTS IN PATIENTS WITH RHEUMATOID ARTHRITIS SWITCHING FROM THEIR FIRST CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG TO ANOTHER DISEASE-MODIFYING ANTIRHEUMATIC DRUG REGIMEN

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2017 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 518-519

Author(s):

R. K. Dore ◽

J. Antonova ◽

L. Chang ◽

M. Gorritz ◽

X. Wang ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Combination Therapy ◽

Real World ◽

Healthcare Costs ◽

Antirheumatic Drug ◽

Treat To Target ◽

Research Support ◽

Total Cost ◽

Disease Modifying ◽

Disease Modifying Antirheumatic Drug

Background:EULAR and ACR guidelines recommend a treat-to-target approach for rheumatoid arthritis (RA). For patients failing their first conventional synthetic disease-modifying antirheumatic drug (csDMARD), EULAR recommends switching to or adding another DMARD. Understanding treatment patterns, durability, and healthcare costs associated with treatments initiated after first csDMARD can help optimize treatment for these patients.Objectives:To describe real-world healthcare costs among patients with RA who failed their first csDMARD.Methods:The study included adults with ≥2 RA claims ≥30 days apart in a large US health claims database, who started a csDMARD regimen as the first DMARD then switched to or added another DMARD (index date [ID], 1/1/2012–3/31/2017). All patients had continuous enrollment 1-year before and ≥1 year after ID. Treatment duration was defined as number of days from initial treatment fill until loss of treatment persistence. Unadjusted mean total annualized per-patient-per-year (PPPY) healthcare costs while on treatment were compared via analysis of variance. A generalized linear model with gamma distribution and log link was used to compare total costs adjusted for pre-index costs, patient characteristics, and type of initiated treatment.Results:The study involved 7,816 patients (median age of 54 yrs, 74% female). Mean (standard deviation) duration of index therapy was 14.0 (12.6) months for patients overall (9.2 [10.1] for monotherapy vs 16.9 [13.1] for combination therapy,P< .0001).Prior to switching, the unadjusted mean PPPY healthcare costs totaled $12,923: $13,923 for monotherapy vs $12,317 (P= .0009) for combination therapy. Once switched, patients accrued unadjusted mean PPPY on-treatment healthcare costs of $30,742: $28,757 on monotherapy vs $31,943 (P= .0003) on combination therapy. Figure 1 details pre- and post-ID unadjusted costs by index therapy.Patients on non-TNFi bDMARD monotherapy had higher adjusted total healthcare cost (cost ratio [CR] = 1.58,P= .0052) than the total cost on JAKi monotherapy, whereas csDMARD monotherapy (CR = 0.28,P< .0001) and csDMARD + csDMARD(s) (CR = 0.26,P< .0001) had lower total cost than the cost on JAKi monotherapy. Other factors impacting costs included baseline Charlson Comorbidity Index (CCI) = 2 or ≥3 vs CCI = 1 (CR = 1.14 and 1.25, respectively; bothP< .0001), baseline total (medical + pharmacy) healthcare costs (CR = 1.24,P< .0001), and baseline opioid use (CR = 1.11,P< .0001, Figure 2).Conclusion:Real-world data demonstrate short durability of available treatments initiated after first csDMARD. Among the initiated treatments, lowest total healthcare costs were associated with csDMARD, followed by JAKi, then TNFi, and finally non-TNFi bDMARD.Disclosure of Interests:Robin K Dore Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Jenya Antonova Employee of: Gilead Sciences. Inc., Lawrence Chang Consultant of: Gilead Sciences, Inc., Magdaliz Gorritz Consultant of: Gilead Sciences, Inc., Xin Wang Consultant of: Gilead Sciences, Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

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Response to: ‘Correspondence on ‘Cardiovascular effects of biological versus conventional synthetic disease-modifying antirheumatic drug therapy in treatment-naive, early rheumatoid arthritis’’ by Georgiadis et al

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-219926 ◽

2021 ◽

pp. annrheumdis-2021-219926

Author(s):

Sven Plein ◽

Maya H Buch

Keyword(s):

Rheumatoid Arthritis ◽

Drug Therapy ◽

Early Rheumatoid Arthritis ◽

Cardiovascular Effects ◽

Antirheumatic Drug ◽

Treatment Naïve ◽

Disease Modifying ◽

Antirheumatic Drug Therapy ◽

Disease Modifying Antirheumatic Drug

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Lack of association between CYB5A gene rs1790834 polymorphism and the response to leflunomide in women with rheumatoid arthritis

European Journal of Clinical Pharmacology ◽

10.1007/s00228-021-03172-3 ◽

2021 ◽

Author(s):

Małgorzata Łączna ◽

Damian Malinowski ◽

Agnieszka Paradowska-Gorycka ◽

Krzysztof Safranow ◽

Violetta Dziedziejko ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Antirheumatic Drug ◽

Disease Modifying ◽

Individual Disease ◽

Disease Modifying Antirheumatic Drug

Abstract Aim Leflunomide is a disease-modifying antirheumatic drug used in therapy for rheumatoid arthritis (RA). Previous studies indicated that oestrogens and androgens may affect the response to leflunomide in RA patients. The synthesis of androgens is regulated by cytochrome CYB5A. The aim of this study was to examine the association between the CYB5A gene rs1790834 polymorphism and the response to leflunomide in women with RA. Methods The study included 111 women diagnosed with RA. Leflunomide was administered in monotherapy at a dose of 20 mg/day. All patients underwent a monthly evaluation for 12 months after the initiation of treatment with leflunomide. Results After 12 months of therapy, the changes in individual disease activity parameters, such as: DAS28, ESR, CRP and VAS, were not statistically significantly different between rs1790834 genotypes in the Kruskal–Wallis test. Conclusions The results of our study suggest lack of statistically significant association between the CYB5A gene rs1790834 polymorphism and the response to leflunomide in women with RA.

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