OBJECTIVES: Poor adherence and persistence on advanced therapies (AT) contribute to suboptimal outcomes in patients with rheumatoid arthritis (RA). Following treatment failure with an initial tumor necrosis factor inhibitor (TNFi), guidelines recommend RA patients be treated with ATs with alternative mechanisms of action. We evaluated 1-year treatment adherence, persistence, and switching for upadacitinib, the most recently approved AT for RA, versus other ATs in TNFi-experienced patients.

METHODS: This retrospective study used data from the Merative® MarketScan® Research Database (August 2018–April 2023). Adult patients diagnosed with RA, initiating an AT (index; date of first pharmacy claim for upadacitinib, tofacitinib, baricitinib, adalimumab, etanercept, abatacept, or tocilizumab) with recent TNFi experience (≤12 months pre-index), and with continuous insurance enrollment for ≥12 months pre- and post-index were included. The proportion of patients adherent to treatment (proportion of days covered ≥80%), discontinuing treatment, and switching treatment was assessed during the 12-month follow-up. Adjusted odds ratios (aOR) and adjusted hazard ratios (aHR) with 95% CIs were calculated for comparisons of treatment adherence and treatment discontinuation or switching, respectively.

RESULTS: At 1 year, compared with upadacitinib initiators, patients initiating each other AT (presented as a range across individual treatments) were significantly less likely to be adherent to treatment (51.0% versus 28.2%–46.0%; aOR range=0.40–0.81) and more likely to discontinue treatment (44.3% versus 49.9%–64.1%; aHR range=1.20–1.87), switch treatment (30.7% versus 38.6%–51.3%; aHR range=1.32–1.90), or discontinue or switch treatment (46.9% versus 55.3%–71.8%; aHR range=1.23–1.99) (all comparisons, P<0.05). Mean time on treatment was greater for upadacitinib initiators (262 days) compared with other AT initiators (197–249 days) through 1 year.

CONCLUSIONS: Overall, treatment adherence was significantly higher, and rates of treatment discontinuation or switching were significantly lower for patients initiating upadacitinib compared with other ATs after recent TNFi treatment.