OBJECTIVES: To describe treatment patterns among patients with rheumatoid arthritis (RA) initiating targeted immune modulators (TIM).

METHODS: Patients with a diagnosis of RA newly initiating a TIM from 2016-2019 were identified in the Veradigm Health Insights Database, a large ambulatory electronic health record (EHR) database in the US. Potential index TIMs included abatacept, adalimumab, anakinra, baricitinib, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab, tociliziumab and tofacitinib. Patients under 18 or those with prior use of a potential index agent were excluded. The index event was the first new use of one of a TIM; patients were required to have one year pre- and two years post-index database activity to establish new TIM use and evaluate study outcomes. Treatment patterns were defined over two years of follow-up, including duration of therapy, switching and discontinuation, defined using a 30 day gap.

RESULTS: The final cohort consisted of 12,080 patients newly initiating a TIM. One-third (37.1%) of patients initiated therapy with adalimumab, followed by etanercept (20.1%), tofacitinib (11.7%), abatacept (8.8%), infliximab (6.2%), certolizumab (4.5%), golimumab (3.7%), tocilizumab (3.3%), and rituximab (2.9%); remaining TIMs had <1.0% each. Overall, one-third (30.4%) of patients remained on their index agent for the full two-year follow-up period; mean duration among the remaining patients was 159.7 days. Among patients switching to a second line TIM, 28.1% continued on their second line TIM until the end of the two-year follow-up period; mean second line therapy duration among the remaining patients was 111.7 days. Approximately 26% of patients progressed to a third line of therapy during the two-year follow-up period, including restarts; one-third of third line patients (30.9%) persisted on third line of therapy until the end of follow-up.

CONCLUSIONS: Duration of TIM treatment continues to be sub-optimal, with only one-third of patients persistent on their index or second line TIM for the two-year follow-up period.