OBJECTIVES : Rheumatoid arthritis (RA) is a common autoimmune condition which is increasingly treated with biologics as monotherapy. This study evaluated treatment patterns among biologic-naïve RA patients prescribed biologics in the Veterans Health Administration (VHA) population.

METHODS : Adult patients with ≥2 diagnosis for RA treated with a biologic (abatacept [ABT], adalimumab [ADA], anakinra [ANK], certolizumab pegol [CZP], etanercept [ETN], golimumab [GOL], infliximab [IFX], rituximab [RTX], and tocilizumab [TOC]) during the identification period (01OCT2014-30SEP2018) were included. The first observed biologic claim was designated as first-line (1L) treatment (index biologic). Patients were excluded if they had any previous biologic claim 12 months prior to index biologic initiation. The Charlson comorbidity index (CCI) score was determined. Patient data were assessed until death or study end. Change in line of treatment was defined as switch to a non-index biologic or restart with the index biologic (restarted index biologic after 60-day gap following run-out-date of index biologic). A Sankey diagram was used to present proportion of patients who transitioned to second-line (2L) and third-line (3L) treatment.

RESULTS : A total of 2,663 RA patients who initiated 1L treatment were included. Mean age was 63.6 years and 85.2% of patients were men. The mean CCI score was 2.2. The 1L biologic therapies included ETN (37.6%), followed by ADA (35.8%), RTX (11.7%), ABT (7.2%), IFX (2.3%), TOC (2.2%), CZP (2.0%), GOL (1.0%), and ANK (0.3%). During the average 2.6-year follow-up period 1,423 (53.4%) patients transitioned to 2L therapy and 685 (25.7%) transitioned to 3L treatment. The most prescribed biologics across multiple lines of treatment were ADA, ETN, and RTX.

CONCLUSIONS : The Sankey diagram may help healthcare providers visually foresee treatment patterns associated with biologic use among RA patients.