Utilization of rheumatoid arthritis medications (Q14-01)

Utilization of rheumatoid arthritis medications (Q14-01)

Q14-01

Overview

What is the Issue?

Guidelines for treatment of rheumatoid arthritis (RA) recommend the use of conventional synthetic DMARDs (csDMARD) as concomitant therapy with biologic disease modifying antirheumatic drugs (bDMARD) after failure of csDMARD treatment alone. Concomitant csDMARD therapy is thought to decrease the risk of discontinuation of bDMARDs, however the literature is inconsistent.

What was the aim of the study?

Incretin-based drugs are popular therapies for the treatment of type 2 diabetes.

How was the study conducted?

CNODES undertook a retrospective cohort study using administrative health databases with 20,221 new users of bDMARDs from 5 Canadian provinces (Alberta, Manitoba, Ontario, Quebec and Sakstachewan) as well as the US IBM® MarketScan® Databases (MScan) between Jan 1, 2007 and March 30, 2014. Exposure to concomitant csDMARD was compared to non-csDMARD exposure. The outcomes were discontinuation of bDMARD therapy, switching of bDMARDs, and percentage change in dose of bDMARD compared to the initial dose. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated and pooled across sites using meta-analysis. The change in dosage was analyzed using linear regression.

What did the study find?

Approximately 76% of the patients were women. Concomitant use of csDMARD therapy was not significantly associated with a reduced discontinuation of bDMARD treatment (HR 0.90; 95% CI: 0.79 to 1.02). Furthermore it was not significantly associated with a reduced switching of bDMARDs (HR 0.95; 95% CI: 0.80 to 1.11).

Implications

There was no clear evidence that RA patients on bDMARDs were less likely to discontinue or switch bDMARDs if they received concomitant csDMARD therapy.

Key Messages
  • This large, international, multi-centre retrospective cohort study provides key data regarding the impact of the concomitant use of csDMARD in rheumatoid arthritis patients using bDMARDs.
  • These data can assist in informing physicians prescribing these medications along with other evidence and patient preferences, while bearing in mind the important limitations of the administrative claims data used in our analysis.

Manuscripts

Fisher A; Hudson M; Platt R; Dormuth C. Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study. The Journal of Rheumatology. 2021 Jan 1;48(1):16-24.

Presentations

Project Team

Project Lead
Colin R. Dormuth ScD
Methods Lead
Robert W. Platt PhD
Methods Lead
Peter Austin PhD
Content Expert
Marie Hudson MD
Steering Committee Liaison
Pierre Ernst MD, MSc, FRCPC
Lead Analyst
Anat Fisher MD, PhD
Research Assistant
Carolina Moriello MSc
Site Investigator
Regina Taylor-Gjevre MSc, MD, FRCPC (C)
Saskatchewan
Site Investigator
Jean-Philippe Lafrance MD, FRCPC, MSc
Quebec
Site Investigator
Michael Paterson MSc
Ontario
Site Investigator
Hala Tamim PhD
Atlantic
Site Investigator
Dan Chateau PhD
Manitoba
Site Investigator
Anat Fisher MD, PhD
MarketScan
Site Investigator
Lauren Bresee PhD
Alberta
Analyst
Shan Jin MSc
Saskatchewan
Analyst
Naoual Elftouh
Quebec
Analyst
Fangyun Wu MSc
Ontario
Analyst
Yan Wang MSc
Atlantic
Analyst
Matthew Dahl BSc
Manitoba
Analyst
Anat Fisher MD, PhD
MarketScan
Analyst
Jianguo (James) Zhang MSc
Alberta
Analyst
Zhihai Ma
Alberta