Utilization Patterns of Disease-Modifying Antirheumatic Drugs in Elderly Rheumatoid Arthritis Patients

Utilization patterns of csDMARDs were highly comparable between drug plans overall (in decreasing order: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, and azathioprine). The proportion of csDMARDs were comparable (e.g., approximately 30% of csDMARD use for methotrexate), although differences in coverage criteria may have resulted in variances in the use of leflunomide. Differences in adjudication of coverage criteria may have resulted in a modest variance in the number of csDMARDs used prior to initiating bDMARDs (i.e., allowing for an “early escape” to bDMARDs for some jurisdictions such as Manitoba and the Atlantic provinces). The mean time to initiate bDMARD therapy (range of 664 to 792 days) revealed a divergence between jurisdictions into 2 groupings whereby Manitoba, Saskatchewan, and the Atlantic provinces drug plans (mean time of 664 to 681 days) saw the initiation of bDMARDs approximately 4 months faster versus other jurisdictions (British Columbia, Alberta, and Ontario, with a mean time of 748 to 792 days), possibly due to their coverage criteria not requiring 3 lines of csDMARDs therapy. Despite differences in the time to initiate bDMARDs, there was no notable difference in the persistence of bDMARDs 6 months after the initiation for any drug plan (61% to 76% range for patients 67 years of age and older). Utilization patterns of bDMARDs was highly comparable between drug plans (i.e., highest use with adalimumab, etanercept, and infliximab), although British Columbia and Manitoba were the only jurisdictions that saw decreasing costs per patient of bDMARDs over time, likely due to a higher uptake of biosimilars or other managed formulary strategies such as tiering.

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Faculty Opinions recommendation of Ability of disease-modifying antirheumatic drugs to prevent or delay rheumatoid arthritis onset: a systematic literature review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733424519.793564294 ◽

2019 ◽

Author(s):

Ladislav Senolt

Keyword(s):

Rheumatoid Arthritis ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Disease Modifying

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FRI0526 THE INCIDENCE, PREVALENCE AND MEDICATION USE OF RHEUMATOID ARTHRITIS AMONG KOREAN WOMEN IN CHILDBEARING YEARS: A NATIONWIDE POPULATION-BASED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4249 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 862.2-863

Author(s):

M. K. Chung ◽

J. S. Park ◽

H. S. Lim ◽

C. H. Lee ◽

J. Lee

Keyword(s):

Rheumatoid Arthritis ◽

Lupus Erythematosus ◽

Medication Use ◽

Population Based ◽

Korean Women ◽

Childbearing Age ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Disease Modifying ◽

Incidence Prevalence

Background:Rheumatoid arthritis (RA) predominantly affects women and has a significant impact on childbearing. Several population-based studies identifying incidence, prevalence, and medication use of RA have been reported, yet epidemiological studies focusing on women with RA in childbearing years are missing.Objectives:We aimed to identify the incidence, prevalence and medication use of RA among Korean women in childbearing years.Methods:From National Health Insurance Service (NHIS) data (2009-2016), containing inpatient and outpatient claim information for approximately 97% of the Korean population, we identified 9,217,139 women aged between 20-44 years. Incidence and prevalence of RA in the specific sociodemographic group of women in childbearing age were analyzed, and the prevalence of medication prescription were compared between women with RA and controls without rheumatic diseases such as RA, systemic lupus erythematosus, and ankylosing spondylitis. Individuals with RA were defined by the presence of International Classification of Disease, 10th revision code, M05. The medication use was defined as receiving > 90days prescriptions of NSAIDs, corticosteroids (CSs), and conventional synthetic (cs) disease modifying antirheumatic drugs (DMARDs) or > 1day prescription of biologic (b) DMARDs.Results:Total 24,590 women with RA were identified. The average incidence of RA during 2011-2016 among women in childbearing years was 24.1/100,000 person-years (PYs) (95% CI 20.91-27.31) with a yearly increase from 20.99/100,000 PYs in 2011 to 28.38/100,000 PYs in 2016. The average prevalence of RA during 2009-2016 among women in childbearing years was 105.2/100,000 PYs (95% CI 99.0-111.5) with a minimum of 95.7/100,000 PYs in 2009 and a maximum of 110.5/100,000 PYs in 2016. There were increasing trends in both incidence and prevalence of RA according to age among women in childbearing years peaking in the age group of 40-44 years. The prescriptions of NSAIDs, CSs, csDMARDs and bDMARDs were more frequent in women with RA than controls (NSAIDs; 94.21% vs 21.79%, CSs; 83.65% vs 4.28%, csDMARDs; 91.23% vs 0.41%, bDMARDs; 0.11% vs 0%, p<0.001).Conclusion:The incidence and prevalence of RA are high among Korean women in childbearing years, and medication use was significantly more frequent in this specific population than controls. High disease burden is imposed upon women in childbearing years.References:[1] Won S, Cho SK, Kim D, Han M, Lee J, Jang EJ, Sung YK, Bae SC: Update on the prevalence and incidence of rheumatoid arthritis in Korea and an analysis of medical care and drug utilization. Rheumatol Int 2018, 38(4):649-656.[2] Smeele HTW, Dolhain R: Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Seminars in arthritis and rheumatism 2019, 49(3s):S32-s35.Table 1.Medication use among women with RA and controls in childbearing age between 20-44 years during 2009-2016Control(n=155,486)RA(n=23,756)n(%)n(%)PNSAIDs33,887(21.79)22,380(94.21)<.0001Steroids6,653(4.28)19,871(83.65)<.0001csDMARDs634(0.41)21,673(91.23)<.0001bDMARDs0(0.00)27(0.11)<.0001RA, rheumatoid arthritis; NSAID, non-steroidal anti-inflammatory drug; cs, conventional synthetic; b, biologic; DMARDs, disease modifying antirheumatic drugsDisclosure of Interests:None declared

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