Real-world Treatment Persistence Research Articles

Real-World Treatment Persistence with Vedolizumab in Crohnʼs Disease and Ulcerative Colitis Patients in the United States (US): A Retrospective Analysis Using the Optum Research Database

Real-World Treatment Persistence with Vedolizumab in Crohnʼs Disease and Ulcerative Colitis Patients in the United States (US): A Retrospective Analysis Using the Optum Research Database

Real-World Treatment Persistence with Vedolizumab in Patients with Ulcerative Colitis and Crohnʼs Disease: A Retrospective Claims Analysis in the U.S.

Real-World Treatment Persistence with Vedolizumab in Patients with Ulcerative Colitis and Crohnʼs Disease: A Retrospective Claims Analysis in the U.S.

P167. Real-world treatment persistence with vedolizumab in Crohn’s disease and ulcerative colitis patients

P167. Real-world treatment persistence with vedolizumab in Crohn’s disease and ulcerative colitis patients

Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence.

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3years showed that GLM had significantly higher persistence than ADA (p=0.022) and ETA (p=0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

Real-World Insulin Treatment Persistence among Patients with Type 2 Diabetes

To evaluate real-world treatment persistence among patients with type 2 diabetes mellitus (T2DM) initiating treatment with insulin. Patient-level data were pooled from 3 previously published observational retrospective studies evaluating patients with T2DM who were previously on oral antidiabetic drugs (OADs) and initiated with a basal analog insulin (insulin glargine or insulin detemir). Treatment persistence was defined as remaining on the study drug during the 1-year follow-up period without discontinuation or switching after study drug initiation. Analyses were conducted to identify baseline factors associated with persistence with insulin therapy and to estimate the association between insulin treatment persistence and patients' clinical and economic outcomes during the follow-up period. A total of 4,804 patients with T2DM (insulin glargine: n = 4,172, insulin detemir: n = 632) were included. The average insulin persistence rate over the 1-year follow-up period was 65.0%. A significantly higher persistence rate was associated with older age, initiation with insulin glargine using either disposable pens or vial-and-syringe, and with baseline exenatide or sitagliptin use. Higher insulin treatment persistence was also associated with lower hemoglobin A1c (A1C) at follow-up, a greater reduction in A1C from baseline, and lower health care utilization. In real-world settings, treatment persistence among patients with T2DM initiating basal insulin is influenced by the type of insulin and patient factors. Greater insulin treatment persistence is linked to improved clinical outcomes and reduced health care utilization.

Abstract P241: Treatment Persistence Among Atrial Fibrillation/Flutter Patients on Combination Warfarin and Antiarrhythmic Drug Therapy in the Real-World Setting

Background: Antiarrhythmic drugs and warfarin (W) are often co-administered for atrial fibrillation/flutter (AF/AFL). Amiodarone (A) potentiates the anticoagulant effect of W, necessitating frequent INR monitoring and dose adjustment. We compared real-world treatment persistence in AF/AFL patients (pts) receiving W + A or W + another Class I/III antiarrhythmic drug (Other AAD). Methods: This retrospective cohort study identified AF/AFL pts ≥18 yrs with concurrent pharmacy claims (≥ 60 days' supply over first 90 days) for W and A or Other AAD from the Ingenix IMPACT database (1997-2009). Eligible pts had ≥1 claims with an AF/AFL diagnosis ≤6 months before starting concomitant W + A or W + Other AAD (‘index date’) and continuous pre- (≥6 months) and post-index (≥12 months) enrollment. Drug discontinuation (≥ 60-day gap between consecutive prescriptions) was recorded over 1 year from the index date. Pts were censored at first discontinuation of either drug (last day with supply before 60-day gap) or after 1 year. Times to drug discontinuation (either drug and W and AAD separately) were compared using Cox proportional hazards models. Results: 4,238 pts (mean age 66.5 yrs; 70% male; mean Charlson Comorbidity Index [CCI] 1.76) received W + A and 6,332 pts (mean age 61.9 yrs; 65% male; mean CCI 0.89) received W + Other AAD. Over 1-year post-index, the W + A cohort had higher rates of discontinuation of warfarin (51.7% vs 43.4%), AAD (53.1% vs 32.9%) or either drug (72.7% vs 58.3%) than the W + Other AAD cohort (all P <0.0001) (Table). After adjusting for demographic/clinical differences, the W + A cohort was at higher risk of discontinuing warfarin (hazard ratio [HR] 1.33, 95% CI 1.25−1.42), AAD (HR 1.92, 95% CI 1.80−2.06) or either drug (HR 1.54, 95% CI 1.46−1.62) than the W + Other AAD cohort (all P <0.0001). Treatment discontinuation rate - either drug 90 days 180 days 360 days Warfarin + Amiodarone 19.1% 48.5% 72.7% Warfarin + Other AAD 14.0% 36.6% 58.3% Conclusion: In real-world practice, AF/AFL pts are less persistent with W + A than with W + Other AAD combination therapy. The reasons for this difference remain to be established.

Cost of non-persistence with oral bisphosphonates in post-menopausal osteoporosis treatment in France.

BackgroundDuring the last decade, oral bisphosphonates (BP) became the most widely prescribed pharmacologic class for post-menopausal osteoporosis. However, many surveys revealed the important issue of poor persistence with those drugs resulting in a failure of treatment to reduce fracture risk sufficiently. Using a published Markov model, this study analyses the economic impact of non-persistence with bisphosphonates in the context of the introduction of generics in France.MethodsDirect costs of vertebral, hip and wrist fracture were assessed and included in an existing 10-year Markov model developed to analyse consequences of non-persistence. Three alternatives of comparison were set: no treatment, real-world persistence, and ideal persistence. Simulated patients' characteristics matched those from a French observational study and the real-world adherence alternative employed persistence data from published database analysis. The risk of fracture of menopausal women and the risk reduction associated with the drugs were based on results reported in clinical trials. Incremental cost-effectiveness ratios (ICERs) were calculated first between real-world adherence and no treatment alternatives, and second between ideal and real-world persistence alternatives. The cost of non-persistence was defined as the difference between total cost of ideal and real-world persistence alternatives.ResultsWithin fractured women population, mean costs of 10-year management of fracture were significantly different between the three alternatives with €7,239 (± €4,783), €6,711 (± €4,410) and €6,134 (± €3,945) in the no-treatment, the real-world and ideal persistence alternatives, respectively (p < 0.0001). Cost-effectiveness ratio for real-world treatment persistence compared with no-treatment alternative was found dominant and as well, alternative of ideal persistence dominated the former. Each ten percentage point of persistence gain amounted to €58 per patient, and extrapolation resulted in a global annual cost of non-persistence of over €30 million to the French health care system, with a substantial transfer from hospital to pharmacy budgets.ConclusionWithin term, improving persistence with oral bisphosphonates should be economically dominant on levels currently known in real-world. Given this potential savings, ambitious adherence-enhancing interventions should be considered in osteoporotic patients.