SAT0086 EVALUATION OF MEDICATION PERSISTENCE IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH NON-TNFI DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Abstract

Background: Persistence to prescribed biologic (b)DMARDs, such as TNF inhibitors (TNFi), in patients (pts) with RA has been suboptimal, with rates ranging from 30-80%. There are limited data on the persistence of non-TNFi bDMARDs and targeted synthetic DMARDs, such as tofacitinib (TOF). Objectives: To compare medication persistence in pts with RA treated with different non-TNFi DMARD treatment options including abatacept (ABA), TOF and tocilizumab (TOC), and to evaluate characteristics (e.g. demographics, comorbidities, baseline treatments) of these pts. Methods: Pts (≥18 years) from the Truven MarketScan™ administrative claims database with RA (≥2 claims for RA identified with International Classification of Diseases [ICD]-9 or ICD-10) being treated with a non-TNFi DMARD from Jan 2006 to Sep 2017 were included. The date of the first claim of a drug of interest on or after diagnosis of RA was considered the index date. Pts were required to have at least 6 months of continuous enrolment prior to the index date (baseline). Pts with claims of other bDMARDs at the index date were excluded from the study. Persistence was defined as the number of days from the index date to the first switch or discontinuation of the index date DMARD, or end of the study period, or end of enrolment, whichever came first. Pts were stratified by prior TNFi use (TNFi-naïve or TNFi-experienced) and by prior corticosteroid (CS) use. Pairwise comparison of persistence between the non-TNFi DMARDs was performed, with ABA as the reference using Kruskal-Wallis test. A p value of <0.05 was considered statistically significant. Results: A total of 30,556 pts satisfied the inclusion and exclusion criteria, of which 20,410, 5048 and 5098 were initially treated with ABA, TOF and TOC, respectively. Overall, the ages of therapy initiation for the ABA and TOF cohorts were comparable, while the TOC cohort was slightly younger. The majority (80%) of the study population was female. The proportion of pts with prior CS use was lower in the ABA cohort vs the other cohorts. Overall, the comorbidity index between treatment cohorts was similar; however, there were some differences in types of comorbidities at baseline (Table 1). The ABA cohort tended to have a lower proportion of pts with chronic obstructive pulmonary disease/asthma, pulmonary nodule, dyslipidaemia and osteoarthritis, while the proportions of pts with heart failure, ischemic heart disease and lupus were higher relative to other cohorts (Table 1). Overall, mean (SD) time on therapy for pts in the ABA cohort was longer compared with pts in the TOF (338 [418] vs 257 [288] days) and the TOC cohorts (338 [418] vs 294 [345] days). Similar differences were observed when further stratified by pts' prior use of TNF and CS (Table 2). Conclusion: Based on the analysis of a large US claims database, pts with RA who were prescribed abatacept had higher persistency with therapy compared with other non-TNFi DMARDs such as TOF and TOC, regardless of prior use of TNFi and CS. Further analysis of medication persistence adjusting for pt characteristics is warranted. (Table presented).