Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by persistent joint synovial inflammation and swelling, leading to cartilage damage and bone erosion. This retrospective, longitudinal study is to evaluate the treatment patterns of biologic-naïve RA patients receiving index biologic disease-modifying antirheumatic drug (bDMARD) and tofacitinib by the data of Taiwan National Healthcare Insurance Claims and the Death Registry between 2012 and 2017. Drug survival and treatment patterns were determined by investigating the occurrence of switching and discontinuation from index treatment. At baseline, 70.0% of patients used tumor necrosis factor inhibitors (TNFi) bDMARD with the majority taking etanercept (27.0%) or adalimumab (26.2%). During the follow-up period, 40.0% (n = 3,464) of index users switched (n = 1,479) or discontinued (n = 1,985) the treatment with an average incidence rate of 0.18 per patient-year. Among the six index treatment groups, drug survival was the lowest for adalimumab and highest for tocilizumab. When compared with etanercept, only adalimumab had a higher cumulative probability of switching/discontinuation (adjusted HR = 1.17, 95% CI: 1.08–1.28), whereas golimumab, non-TNFi bDMARDs and tofacitinib were significantly less probable to switch or discontinue. For patients switching the index treatment, tocilizumab (31.2%) and tofacitinib (23.4%) were the main regimens being switched to. In addition, 48.2% of patients who discontinued the index treatment received further retreatment, and 63.8–77.0% of them were retreated with same agent. In conclusion, this population-based study found that TNFi were the preferred agents as the index treatments during 2012–2017. Non-TNFi and tofacitinib were more common second-line agents being switched to. Nearly half of discontinued patients received retreatment, with a majority receiving the same agent.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease affecting 0.3–1.0% of the general population with higher prevalence in women and in developed countries (Latimer et al, 2019)
By using the population-based National Health Insurance Research database (NHIRD) in Taiwan, the present study aims to assess the cumulative probability of switching or discontinuation of the index treatment of biologic disease-modifying antirheumatic drug (bDMARD) and tofacitinib, and to describe treatment patterns for patients who switched or were re-treated after discontinuing their index treatment
Among the 957 patients who were retreated after discontinuation, 63.8–77.0% of them were retreated with the same index treatment (Table 4). In this retrospective cohort study using 2012–2017 populationbased claims in the NHIRD, we assessed the initiation and switching/discontinuation patterns in the treatment of biologic-naïve RA patients in Taiwan who used bDMARDs and tofacitinib. This is the first population-based study in Taiwan that investigated the treatment patterns prescribing bDMARDs and tofacitinib from 2012 to 2017, during which several newer classes of biologics were introduced for reimbursement
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease affecting 0.3–1.0% of the general population with higher prevalence in women and in developed countries (Latimer et al, 2019). The pathophysiology of RA is characterized by persistent joint synovial inflammation and swelling, leading to cartilage damage and bone erosion. Extra-articular manifestations that affect various organs are common with the progression of RA. Compared with the general population, patients with RA have a higher mortality rate in addition to RA comorbidities, such as cardiovascular, respiratory, and infectious diseases (van den Hoek et al, 2017). The estimated prevalence of RA varied among countries in East Asia (e.g., 0.28% in China, 0.6% in Japan, and 0.32% in South Korea) (Li et al, 2012; Yamanaka et al, 2014; Won et al, 2018). In Taiwan, a nationwide population study using catastrophic illness registry data reported a relatively lower yet rising prevalence of RA from 0.07% in 2002 to 0.12% in 2007 (Kuo et al, 2013)
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