Abstract
Tumor necrosis factor inhibitor (TNFi) therapies are often the first biologic therapy used to treat rheumatoid arthritis (RA) patients. However, a substantial fraction of patients do not respond adequately to TNFi therapies. A test with the ability to predict response would inform therapeutic decision-making and improve clinical and financial outcomes. A 32-question decision-impact survey was conducted with 248 rheumatologists to gauge the perceived clinical utility of a novel test that predicts inadequate response to TNFi therapies in RA patients. Participants were informed about the predictive characteristics of the test and asked to indicate prescribing decisions based on four result scenarios. Overall, rheumatologists had a favorable view of the test: 80.2% agreed that it would improve medical decision-making, 92.3% said it would increase their confidence when making prescribing decisions, and 81.5% said it would be useful when considering TNFi therapies. Rheumatologists would be more likely to prescribe a TNFi therapy when the test reported that no signal of non-response was detected (79.8%) and less likely to prescribe a TNFi therapy when a signal of non-response was detected (11.3%–25.4%). Rheumatologists (84.7%) agreed that payers should provide coverage for such a test. This study shows that rheumatologists support the clinical need for a test to predict inadequate response to TNFi therapies. Test results were perceived to lead to changes in prescribing behaviors as results instill confidence in the ordering rheumatologist.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects about 1.3 million U.S adults [1]
The American College of Rheumatology (ACR) guidelines support the use of any targeted therapy, regardless of MOA, for the treatment of RA following inadequate response to a csDMARD [3]
Tumor necrosis factor inhibitor (TNFi) therapies are usually the first biologic tried after the failure of csDMARDs [4]
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects about 1.3 million U.S adults [1]. Rheumatology International (2021) 41:585–593 treatment cycles may be needed to find the appropriate therapeutic for an individual patient before adequate disease control is achieved. Such a “trial-and-error” approach increases overall costs while decreasing patient satisfaction [2]. Tumor necrosis factor inhibitor (TNFi) therapies are usually the first biologic tried after the failure of csDMARDs [4]. This prescribing behavior is reinforced by the current medical policies of insurers, which mostly cover TNFi therapies as the only first-tier treatment following csDMARD failure [5,6,7,8]. Precision medicine can alter this treatment paradigm to better meet the needs of individual patients, as has happened in other medicine fields, such as oncology [11,12,13]
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