Real-World Use of Biologic Disease-Modifying Anti‑Rheumatic Drugs in US Patients with Ankylosing Spondylitis: Persistence, Factors Associated with Discontinuation, and Dosing Patterns

Author(s)

Dubreuil M1, Walsh JA2, Deodhar A3, Gensler LS4, Curtis JR5, Anjohrin S6, Pilipczuk O7, Feudjo Tepie M8, Beaty S9, Mørup M10, Taieb V11, Welby S12
1Boston University School of Medicine, Boston, MA, USA, 2Salt Lake City Veterans Affairs Health and University of Utah Health, Salt Lake City, UT, USA, 3Oregon Health and Science University, Portland, OR, USA, 4University of California, San Francisco, CA, USA, 5University of Alabama at Birmingham, Birmingham, AL, USA, 6UCB Pharma, Tallahassee, FL, USA, 7UCB Pharma, Brussels, Belgium, 8UCB Pharma, Smyrna, GA, USA, 9UCB Pharma, Tucker, GA, USA, 10UCB Pharma, Copenhagen, Denmark, 11UCB Pharma, Colombes, France, 12UCB Pharma, Loupoigne, Belgium

OBJECTIVES:

Discontinuation of biologic disease-modifying anti‑rheumatic drugs (bDMARDs) is common and associated with poor clinical outcomes in ankylosing spondylitis (AS). We assessed bDMARD persistence, factors associated with bDMARD discontinuation, and dosing patterns in patients with AS using IBM® MarketScan® US claims databases.

METHODS:

Adult patients with AS (≥1 ICD-9/10 code) initiating a new bDMARD from 1Jan2015–31Dec2018 were followed for up to 12 months or until bDMARD discontinuation (≥90‑day gap in therapy/change in biologic) or MarketScan disenrollment. Predictors of non‑persistence were estimated using Cox regression. Dosing patterns (>5 weeks after index date) were described only for patients initiating secukinumab, due to differences in prescribing recommendations.

RESULTS:

2,437 patients with AS initiated a new bDMARD (mean age: 44.7 years; 46.7% female; any baseline comedication use: 85.4%; baseline NSAID use: 47.4%). The estimated 12‑month drug survival probability (persistence) was 56.4%. Persistence was similar with tumor necrosis factor (TNF) inhibitors (56.3%; n=2,322) and interleukin-17 (IL‑17) inhibitors (58.4%; n=115 [secukinumab: n=114]), and among biologic-naïve (56.6%; n=2,286) and biologic‑experienced patients (53.5%; n=151). Strong predictors of non‑persistence were female gender (hazard ratio [95% confidence interval]: 1.63 [1.42–1.86]), multiple comorbidities (1.35 [1.06–1.73]), and baseline opioid use (1.25 [1.08–1.46]). Use of multiple baseline comedications reduced the likelihood of non‑persistence (0.76 [0.62−0.93]).

Of 114 patients with AS initiating secukinumab, 91 had starting and 76 had maintenance dose records. 70/91 (76.9%) patients started the recommended 150mg dose and 18/91 (19.8%) 300mg. During follow-up, 46/76 (60.5%) and 16/76 (21.1%) patients received 150mg and 300mg every four weeks maintenance dosing throughout, respectively, while 10/76 (13.2%) were dose-escalated (150mg to 300mg).

CONCLUSIONS:

Real-world data of US patients with AS showed a 12-month bDMARD persistence rate of 56.4%. bDMARD non-persistence appeared to be affected by specific baseline characteristics, which may identify patients who require additional management.

Conference/Value in Health Info

2023-05, ISPOR 2023, Boston, MA, USA

Value in Health, Volume 26, Issue 6, S2 (June 2023)

Code

RWD136

Topic

Real World Data & Information Systems

Topic Subcategory

Health & Insurance Records Systems

Disease

Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)

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