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Physicians should consider prescribing non-anti TNF bDMARDs as 2nd bDMARD treatment as chances to discontinue therapy was found to be low compared to other second bDMARDs.
Rheumatoid arthritis (RA) is a constant requisite autoimmune inflammatory activity with a prevalence of ≥1% in western countries. Current treatment guidelines suggested methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD), also with glucocorticoids to be administered to most newly diagnosed RA patients. If MTX treatment fails to improve symptoms or fails to reach the therapy target, it is endorsed to switch to another sDMARD (e.g., sulfasalazine, leflunomide, hydroxychloroquine) or to add a biological DMARD (bDMARD) to MTX treatment. Since persistence to first biologic disease modifying anti-rheumatic drugs (bDMARDs) is far from ideal in rheumatoid arthritis (RA) patients, many do undergo a second and third bDMARD treatment. However, there is not much known about treatment persistence of the second-line bDMARD, and it is precisely unknown whether the mechanism of such a therapy is related to various persistence rates. It was aimed to assess discontinuation-, re-initiation- or continuation-rates of a 2nd bDMARD treatment as well as switching-rates to a third biologic DMARD (3rd bDMARD) treatment in RA patients.
The analysis was based on German claims data (2010–2013). Patients were involved if they had undergone at least one prescription for an anti-TNF and at least one look into the prescription of a 2nd bDMARD vary from the first anti-TNF. Patient follow-up began on the first prescription date of 2nd bDMARD and lasted for 12 months or until a patient’s death.
Out of 2667 RA patients receiving at least one anti-TNF prescription, 451 patients underwent a second bDMARD (340 anti-TNF, mean age 52.6 years; 111 non-anti-TNF, mean age 55.9 years). During investigation, 28.8% vs. 11.7% of the 2nd anti-TNF vs. non-anti-TNF patients (p < 0.001) switched to a 3rd bDMARD; 14.1% vs. 19.8% (p = 0.179) put at end to short of re-start; 3.8% vs.1.8% (p = 0.387) re-started and 53.5 vs. 66.7% (p < 0.050) carry on with treatments. Patients in the non-anti-TNF group exhibited longer drug survival (295 days) than patients in the anti-TNF group (264 days; p = 0.016). Independent variables associated with earlier discontinuation (including re-start) or switch were prescription of an anti-TNF as 2nd bDMARD (HR =1.512) and a higher comorbidity level (CCI, HR =1.112), whereas previous painkiller medication (HR = 0.629) was related to later discontinuation or switch.
Only 56.8% of RA patients continued 2nd bDMARD therapy after 12 months; 60% if re-start was included. Non-anti-TNF patients had a higher possibility of continuing 2nd bDMARD therapy.
BMC Musculoskeletal Disorders
Drug survival of second biological DMARD therapy in patients with rheumatoid arthritis: a retrospective non-interventional cohort analysis
Thomas W. et al.
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