THU0664 Treatment adherence to conventional and biologic disease modifying antirheumatic drugs in patients with rheumatoid arthritis. (12th June 2018)

• Record Type: Journal Article
• Authors: Feldman, C.H.; Lii, J.; Gopalakrishnan, C.; Franklin, J.M.; Kim, S.C.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 526
• Page End: 526
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.5544
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: While treatment with conventional or biologic disease-modifying antirheumatic drugs (DMARDs) is highly effective in preventing radiographic progression and improving long-term functional outcome among patients with rheumatoid arthritis (RA), patient adherence to DMARD treatment is required for these positive effects. Suboptimal medication adherence has been repeatedly noted in patients with chronic medical conditions including RA. Objectives: To examine patient adherence to different DMARDs for RA in a real-world setting. Methods: We conducted a population-based cohort study using claims data from a US commercial health plan (Optum Clinformatics TM Datamart 2004–2015) and Medicaid (2000–2010). Eligible patients were those aged between 18 and 65 years and had at least two visits, 7–365 days apart, coded for RA (ICD-9: 714.xx). We then identified patients who newly started a conventional or biologic DMARD. The index date was the first dispensing date of conventional or biologic DMARDs after a 12 month continuous enrollment period. We examined patient demographics, clinical characteristics and health care utilisation factors specific to DMARDs types and their adherence to conventional or biologic DMARDs. All patients were required to be continuously enrolled for at least 1 year after the index date. Patients' adherence to each DMARD was measured using the proportion of days covered (PDC) calculated as the number of days suppled divided by 365 days post-index. Results: We identified a total of 77, 999 RA patients (37 018 in Optum and 40 981 in Medicaid) who started a conventional or biologic DMARD. Of those, 28 332 initiated methotrexate, 27 157 hydroxychloroquine, 6505 sulfasalazine, 2773 leflunomide and 19 381 biologic DMARDs. Table 1 shows patients' adherence specific to DMARD types. Overall, adherence was better in patients enrolled in Optum (i.e., a commercial health plan) than Medicaid. Except for infliximab given only intravenously, the PDC for the 1 year after initiating a conventional or biologic DMARD ranged from 30.99% (sulfasalazine in Medicaid) to 60.84% (abatacept in Optum). Conclusions: In this large population-based cohort of RA patients enrolled in a commercial health plan or Medicaid, the 1 year medication adherence is generally low regardless of type of DMARDs. While adherence is better in the commercial health plan cohort than Medicaid, other factors predicting medication adherence need to be determined further. There is a strong need for future research examining the impact of medication adherence on long-term RA-related clinical outcomes. Disclosure of Interest: C. Feldman: None declared, J. Lii: None declared, C. Gopalakrishnan: None declared, J. Franklin: None declared, S. Kim Grant/research support from: Pfizer, Bristol Myers Squibb, Roche