Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Adeeba Al‐Herz ,Husain Bahbahani,Hoda Tarakmeh,Fatemah Abutiban,Naser Alhadhood,A Ghanem ,E Nahar ,Mohammed Hussain,Ali Aldei,Ghada Mazloum,Ramia Alsouk,Hebah Alhajeri,Ahmad Khadrawy,Youssef Bartella,Sally Hamed,Khaled Mokaddem,A Alenizi ,Waleed Al-Kandari,Eman Hasan,Khuloud Saleh,A Zaman ,Yousef Ali ,Sawsan Hayat,Ammad Fazal,Adel Al-Awadhi,Ahmad Alsaber

doi:10.1007/s10067-020-05444-2

Abstract

ObjectiveBiologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or patients with contraindications to cDMARDs or poor prognostic factors. The purpose of this study was to compare the prescription rates of biologics in Kuwaiti and non-Kuwaiti patients and to assess whether this had an impact on disease activity and quality of life in RA patients.MethodsData were extracted from the Kuwait Registry for Rheumatic Diseases. Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. The treatment agents, disease activity, and quality of life of Kuwaiti patients were compared with non-Kuwaiti patients.ResultsA total of 1651 RA patients were included; 806 (48.8%) were Kuwaiti patients. Among Kuwaiti patients, 62.5% were on biologic drugs in comparison with 14% of non-Kuwaiti patients. In comparison with non-Kuwaiti patients, Kuwaiti patients had significantly lower numbers of swollen joints (p < 0.001) and disease activity score-28 scores (p = 0.02) and less steroid use (p < 0.001) yet a significantly higher health assessment questionnaire-disability index (p < 0.001). Regression analysis showed that DAS-28 scores were significantly associated with the treatment type (p < 0.001) and that nationality was significantly predictive of the treatment type (p < 0.001).ConclusionIn the setting of easy accessibility to treatment for Kuwaiti patients, biologics were prescribed by rheumatologists at a higher rate than for non-Kuwaitis. This may explain the lower disease activity and the lower rate of steroid use in Kuwaiti patients than non-Kuwaitis.Key points• Significant discrepancies in the rates of prescribing biologic therapies between KP and NKP in Kuwait were observed.• Several treatment outcomes were significantly better in the KP group than in the NKP group even after adjustment of confounding factors.• The poor access to biologic therapies was suggested to limit the effectiveness of RA treatments in the NKP group.

Highlights

Rheumatoid arthritis (RA) is an autoimmune disease that affects 0.25 to 1% of the global population [1, 2]
Despite the availability of biological therapy options in the Middle East, there still is undertreatment of RA patients eligible for biologics
The current study showed significant discrepancies in the rates of prescribing biologic therapies between Kuwaiti patients (KP) and nonKuwaiti patients (NKP) in Kuwait

Summary

Introduction

Rheumatoid arthritis (RA) is an autoimmune disease that affects 0.25 to 1% of the global population [1, 2]. In Kuwait, around 1% of the population is estimated to have RA [3]. Several biological drugs have been approved by the FDA for the treatment of RA. These include drugs targeting tumor necrosis factor (TNF-α), interleukin (IL)–1, IL-6, B lymphocytes, and T lymphocyte co-stimulatory molecules. All these drugs have shown marked efficacy in clinical trials, especially in combination with methotrexate [5, 6]

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Results

Conclusion