Abstract
Objective:To compare anti-TNF dose escalation, DMARD and/or glucocorticoid intensification, switches to another biologic, and drug and drug-related costs over 12 and 18 months for rheumatoid arthritis (RA) patients initiating etanercept (ETN), adalimumab (ADA), or infliximab (IFX) in routine clinical practice across Canada.Methods:A retrospective chart review of biologic-naïve adult RA patients newly initiating ADA, ETN, or IFX between January 01, 2006 and December 31, 2012 from 11 practices across Canada.Results:There were 314 patients in the 12-month analysis and 217 in the 18-month analysis. No dose escalation occurred with ETN over 12 and 18 months versus 38% and 32% for IFX (p<0.001) and 2% and 2% for ADA (p=0.199, p=0.218). Over 18 months, dose escalation and/or DMARD and/or glucocorticoid intensification was less frequent among ETN (16%) versus IFX (44%, p=0.005) and ADA (34%, p=0.004). By 18 months, 22% of patients initiating ADA had switched to another biologic compared with 6% of ETN patients (p=0.001).Patients initiating ETN had lower total (drug and drug-related) costs over 12 and 18 months compared to IFX, and no difference compared to ADA when adjusted for potential confounders. Patients with dose escalation had higher costs compared to those with no dose escalation.Conclusion:Physicians were more likely to escalate the dose of IFX, but optimize co-therapy with ADA and ETN. ETN patients had no dose escalation and were less likely to have DMARD and/or glucocorticoid intensification than ADA patients. ETN-treated patients had lower costs compared to IFX patients.
Highlights
Rheumatoid arthritis (RA), a progressive disease requiring lifelong treatment, affects approximately 1% of the Canadian population [1]
Over 18 months, dose escalation and/or disease-modifying antirheumatic drugs (DMARDs) and/or glucocorticoid intensification was less frequent among ETN (16%) versus IFX (44%, p=0.005) and ADA (34%, p=0.004)
115 patients excluded from 12- month population Etanercept (N=55) Infliximab (N-9) Adalimumab (N=51)
Summary
Rheumatoid arthritis (RA), a progressive disease requiring lifelong treatment, affects approximately 1% of the Canadian population [1]. The effectiveness of current therapies, including disease-modifying antirheumatic drugs (DMARDs), antitumor necrosis factor (TNF) agents, and other biologic drugs have made these goals achievable. The most commonly prescribed anti-TNF agents, etanercept (ETN), infliximab (IFX), and adalimumab (ADA), have proven effective at reducing signs and symptoms and slowing progression of RA [2]. Studies have shown that patients receiving either ADA or IFX developed neutralizing antibodies against the drugs, contributing to a loss of therapeutic response [4 - 8]. Due to inadequate therapeutic response, clinicians often escalate or intensify the dose of the drug or switch to another biologic agent [7 - 10]. Dose escalation increases drug treatment costs [11 - 14], patient inconvenience, and risk of adverse events (e.g., infusion reactions, infections) [15 - 17], without necessarily offering additional clinical benefit [11, 18 - 20]
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