National and regional dose escalation and cost of tumor necrosis factor blocker therapy in biologic-naïve rheumatoid arthritis patients in US health plans

Objective.Patients with rheumatoid arthritis (RA) commonly switch between tumor necrosis factor (TNF) inhibitors after failing to control disease activity. Much of the clinical data that support switching to a second TNF agent when one agent fails to work has come from small, short-term studies. We utilized a US insurance claims database to determine patterns of use such as dose escalation, time to discontinuation, and switching between TNF inhibitors in patients with RA.Methods.A retrospective analysis was performed using an insurance claims database in the US from 2000 to 2005. TNF inhibitor use, time to switch, dose escalation, and continuation times were analyzed in patients with RA.Results.Nine thousand seventy-four patients with RA started TNF inhibitors during the period 2000 to 2005. Etanercept was the most commonly used TNF inhibitor; infliximab had the highest duration of continuation, about 50% at 2 years. In addition, infliximab showed higher rates of dose escalation compared to etanercept and adalimumab. For all TNF inhibitors, time to switching decreased from 2000 to 2005.Conclusion.TNF inhibitor use patterns changed from 2000 to 2005, with more frequent changes among the different TNF inhibitors and a shorter duration of treatment before the change. Only about 50% of TNF inhibitors are still continued at 2 years, reflecting the difference between randomized clinical trials and real-world experience.

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SAT0143 Tumor necrosis factor-blocker use in us managed care: Utilization and dosing patterns among rheumatoid arthritis patients:

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-eular.3090 ◽

2013 ◽

Vol 71 (Suppl 3) ◽

pp. 520.1-520

Author(s):

M. Fisher ◽

C. Watson ◽

K.M. Fox ◽

Y.-W. Chen ◽

S.R. Gandra

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Managed Care ◽

Tumor Necrosis ◽

Care Utilization ◽

Tumor Necrosis Factor Blocker ◽

Necrosis Factor ◽

Dosing Patterns

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Persistence and Dose Escalation of Tumor Necrosis Factor Inhibitors in US Veterans with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.140164 ◽

2014 ◽

Vol 41 (10) ◽

pp. 1935-1943 ◽

Cited By ~ 17

Author(s):

Grant W. Cannon ◽

Scott L. DuVall ◽

Candace L. Haroldsen ◽

Liron Caplan ◽

Jeffrey R. Curtis ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Disease Activity ◽

Dose Escalation ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Inhibitor ◽

Administrative Databases ◽

Factor Inhibitor ◽

Effectiveness Studies ◽

Necrosis Factor

Objective.Limited evidence exists comparing the persistence, effectiveness, and costs of biologic therapies for rheumatoid arthritis in clinical practice. Comparative effectiveness studies are needed to understand real-world experience with these agents. We evaluated treatment patterns, costs, and effectiveness of tumor necrosis factor inhibitor (TNFi) agents in patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry.Methods.Observational data from the VARA registry and linked administrative databases were analyzed. Longitudinal data from VARA patients initiating adalimumab (ADA), etanercept (ETN), or infliximab (IFX) from 2003 (the date all agents were available within the Veteran Affairs) to 2010 were analyzed. Outcomes included Disease Activity Score using 28 joints (DAS28), treatment persistence, dose escalation, and direct costs of drugs and drug administration.Results.For 563 eligible patients, baseline DAS28, DAS28 improvements, and persistence on initial treatment were similar across agents. Fewer patients receiving ETN (n = 5/290; 2%) underwent dose escalation than did patients taking ADA (n = 32/204; 16%) or IFX (n = 44/69; 64%). Annual costs for first course of TNFi therapy were lower for injectable ADA ($13,100 US) and ETN ($13,500 US) than for intravenously administered IFX ($16,900 US).Conclusion.Despite similar persistence and clinical disease activity for these TNFi agents, rates of dose escalation were highest with ADA and IFX. Higher overall costs were noted for IFX without increases in effectiveness.

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