Use of Anti-Tumor Necrosis Factor Therapy: A Retrospective Study of Monotherapy and Adherence to Combination Therapy with Non-Biologic Disease-Modifying Anti-Rheumatic Drugs. Issue 2 (December 2015)

• Record Type: Journal Article
• Authors: Engel-Nitz, Nicole; Ogale, Sarika; Kulakodlu, Mahesh
• Is Part Of: Rheumatology and therapy. Volume 2:Issue 2(2015)
• Page Start: 127
• Page End: 139
• Publication Date: 2015-12
• Subjects: Adherence -- Anti-TNF therapy -- Combination therapy -- Discontinuation -- DMARD -- Persistence -- Rheumatoid arthritis; Joints -- Diseases -- Treatment -- Periodicals; Connective tissues -- Diseases -- Treatment -- Periodicals; Rheumatology -- Periodicals; 616.72306
• DOI: 10.1007/s40744-015-0015-x
• Languages: English
• ISSNs: 2198-6576

Abstract

Abstract Introduction This study examined the use of anti-tumor necrosis factor (anti-TNF) monotherapy, adherence with non-biologic disease-modifying anti-rheumatic drugs (nbDMARDs) in patients receiving a combination of anti-TNF therapies and nbDMARDs, and the impact of nbDMARD adherence on anti-TNF persistence among patients with rheumatoid arthritis (RA). Methods Patients with RA (aged ≥18 years) from a US commercial health plan with claims for anti-TNFs (2006–2010) were defined as either biologic-naive or -exposed anti-TNF initiators based on previous nbDMARD use. Adherence to nbDMARDs and anti-TNF persistence were estimated. Cox regression estimated the association between nbDMARD adherence and anti-TNF persistence. Results Among 9764 patients identified (mean age 50.2 years; 78% female), 55% of biologic-naive patients and 49% of previously exposed patients initiated any combination therapy during follow-up. Among biologic-naive combination therapy patients, 53% adhered to nbDMARD therapy <80% of the time while receiving anti-TNF therapies; 33% had <60% adherence. Compared with the most adherent patients, patients adherent to nbDMARDs 20% to 79% of the time were 30% to 20% more likely to discontinue their anti-TNF therapy in the period >90 days after starting the anti-TNF therapy. This relationship was not observed for patients with nbDMARD adherence of <20% (who were less likely to discontinue their anti-TNF therapy during the first 90 days of treatment). Conclusion Almost one-third of patients with RA receiving anti-TNF therapy received it as pure monotherapy. About one-third of combination therapy recipients had <60% adherence to nbDMARDs. Higher nbDMARD adherence may be associated with better anti-TNF persistence after an initial treatment period.