PBI20 Physician Reported Reasons for Advanced Therapy Treatment Switches in Rheumatoid Arthritis Patients: Results From a Cross-Sectional Survey in the USA

Abstract

A variety of advanced therapies (biologic disease-modifying anti-rheumatic drugs “bDMARDs” and Janus kinase inhibitors “JAKs”) are licensed for RA treatment. Little is known about reasons for switching between therapies. To describe patterns of switching and physician-reported reasons for switch among bDMARDs (tumour necrosis factor inhibitors “TNFi”, non-TNFi) and JAKs by line of therapy in USA RA patients. The Adelphi RA Disease Specific Programme is a cross-sectional survey of USA rheumatologists (n=86) which ran from Q4 2019 – Q3 2020. Rheumatologists completed an online survey and medical record extraction for their next 12 consecutive patients (n=1027). Rheumatologists reported frequency of switches at first and second line and reasons for switching treatment. Rheumatologists reported 60% (n=614) of all patients were prescribed a bDMARD/JAK. 74% were receiving their first bDMARD/JAK, of which 68% were receiving a TNFi, 21% JAK, and 11% non-TNFi. Rheumatologists’ most frequent reason for choosing the first line treatment was based on clinical parameters, especially strong efficacy. Of patients who had switched first to second line therapy, the most common switching patterns were from a TNFi to another TNFi (44%); from TNFi to non-TNFi (28%); TNFi to JAK (17%); and JAK to TNFi (4%). Of the patients who switched from second to third line the most common switching pattern was from TNFi to non-TNFi (25%). The main reason for switching was a loss of response (TNFi to TNFi: 45%; TNFi to non-TNFI: 72%; TNFI to JAK: 50%). Current RA treatment landscape analysis shows, in the USA, bDMARDs are the most frequently prescribed first advanced therapy, and that most switches are between biologics, particularly from one TNFi to another. The main reason physicians reported switching therapies was loss of efficacy.