James Harnett1, Daniel Wiederkehr2, Robert Gerber3, David Gruben4, Jeffrey Bourret5, Andrew Koenig5. 1. 1 Senior Director, Real World Data and Analytics, Worldwide Policy, Pfizer, New York, New York. 2. 2 Director, Worldwide Policy, Pfizer, New York, New York. 3. 3 Senior Director, Outcomes and Evidence, Statistics, Pfizer, Groton, Connecticut. 4. 4 Senior Director, Statistics, Pfizer, Groton, Connecticut. 5. 5 Senior Director, North America Medical Affairs, Pfizer, Collegeville, Pennsylvania.
Abstract
BACKGROUND: Adherence to biologic disease-modifying antirheumatic drugs (bDMARDs) among patients with rheumatoid arthritis (RA) is often suboptimal in routine clinical practice. Low or nonadherence can reduce the effectiveness of bDMARD therapies. OBJECTIVE: To evaluate filling of newly prescribed initial bDMARDs for the treatment of RA and evaluate potential for characterizing treatment decisions and patient outcomes. METHODS: In this retrospective cohort analysis, patients aged ≥ 18 years with an RA diagnosis (ICD-9-CM code 714.xx) were selected from a de-identified database of clinical information from the Electronic Health Record (EHR; Humedica) database linked to health care claims (Optum) from commercial and Medicare Advantage health plans (2007-2013). The first biologic prescription date in EHR was the index date. Patients were categorized as filling the prescription within 30 days (early fillers), 31-180 days (late fillers), or not at all within 180 days (nonfillers) of index date. RESULTS: Of 373 patients meeting inclusion criteria, 170 (45.6%), 59 (15.8%), and 144 (38.6%) were categorized as early fillers, late fillers, and nonfillers, respectively. Most prescriptions were written or ordered for tumor necrosis factor inhibitors (88.7%). Compared with late and nonfillers, early fillers were younger and more likely to be female, with higher pain scores (among those reporting pain scores) and RA severity scores pre-index, and filled more prescriptions for any reason pre-index. More nonfillers (66.0%) were Medicare patients than early (17.7%) and late (35.6%) fillers. During days 0-30 post-index, conventional synthetic DMARD use was greatest for early fillers (45.9%) and lowest among nonfillers (24.3%); however, during days 31-180 post-index, the proportion was highest for late fillers (61.0%) and lowest for nonfillers (35.4%). Of early fillers, 12.9% did not fill/receive a bDMARD after 30 days. Only 23 patients had pre/post-index pain scores, and 47 patients had a rationale for stopping or not filling a bDMARD. In patients with pharmacy and medical coverage for 180 days post-index, early fillers had greater RA-related pharmacy and medical resource use and costs than late and nonfillers combined. CONCLUSIONS: These findings confirm a high rate of primary nonadherence to bDMARDs among patients with RA.
BACKGROUND: Adherence to biologic disease-modifying antirheumatic drugs (bDMARDs) among patients with rheumatoid arthritis (RA) is often suboptimal in routine clinical practice. Low or nonadherence can reduce the effectiveness of bDMARD therapies. OBJECTIVE: To evaluate filling of newly prescribed initial bDMARDs for the treatment of RA and evaluate potential for characterizing treatment decisions and patient outcomes. METHODS: In this retrospective cohort analysis, patients aged ≥ 18 years with an RA diagnosis (ICD-9-CM code 714.xx) were selected from a de-identified database of clinical information from the Electronic Health Record (EHR; Humedica) database linked to health care claims (Optum) from commercial and Medicare Advantage health plans (2007-2013). The first biologic prescription date in EHR was the index date. Patients were categorized as filling the prescription within 30 days (early fillers), 31-180 days (late fillers), or not at all within 180 days (nonfillers) of index date. RESULTS: Of 373 patients meeting inclusion criteria, 170 (45.6%), 59 (15.8%), and 144 (38.6%) were categorized as early fillers, late fillers, and nonfillers, respectively. Most prescriptions were written or ordered for tumornecrosis factor inhibitors (88.7%). Compared with late and nonfillers, early fillers were younger and more likely to be female, with higher pain scores (among those reporting pain scores) and RA severity scores pre-index, and filled more prescriptions for any reason pre-index. More nonfillers (66.0%) were Medicare patients than early (17.7%) and late (35.6%) fillers. During days 0-30 post-index, conventional synthetic DMARD use was greatest for early fillers (45.9%) and lowest among nonfillers (24.3%); however, during days 31-180 post-index, the proportion was highest for late fillers (61.0%) and lowest for nonfillers (35.4%). Of early fillers, 12.9% did not fill/receive a bDMARD after 30 days. Only 23 patients had pre/post-index pain scores, and 47 patients had a rationale for stopping or not filling a bDMARD. In patients with pharmacy and medical coverage for 180 days post-index, early fillers had greater RA-related pharmacy and medical resource use and costs than late and nonfillers combined. CONCLUSIONS: These findings confirm a high rate of primary nonadherence to bDMARDs among patients with RA.
Authors: Diana Brixner; Manish Mittal; David T Rubin; Philip Mease; Harry H Liu; Matthew Davis; Arijit Ganguli; A Mark Fendrick Journal: Patient Prefer Adherence Date: 2019-09-13 Impact factor: 2.711
Authors: Kaleb Michaud; Bernard Vrijens; Eric Tousset; Sofia Pedro; Rebecca Schumacher; Gorana Dasic; Connie Chen; Ekta Agarwal; Maria E Suarez-Almazor Journal: ACR Open Rheumatol Date: 2019-09-06
Authors: Hong J Kan; Kirill Dyagilev; Peter Schulam; Suchi Saria; Hadi Kharrazi; David Bodycombe; Charles T Molta; Jeffrey R Curtis Journal: Arthritis Res Ther Date: 2018-05-02 Impact factor: 5.156
Authors: Leah L Zullig; Dan V Blalock; Samantha Dougherty; Rochelle Henderson; Carolyn C Ha; Megan M Oakes; Hayden B Bosworth Journal: Patient Prefer Adherence Date: 2018-07-13 Impact factor: 2.711