High Drug Switching and Low Persistence in Rheumatoid Arthritis Save

Mease and colleagues have catalogued the current practices assessed in the CORRONA registry, noting that increased DMARD switching and decreased time on a given therapy by US physicians.

This retrospective analysis assessed treatment patterns among patients newly initiated on biologic and/or nonbiologic RA therapy within the US Corrona RA registry between 2007 and 2015.

Among the 8027 RA patients, csDMARD monotherapy and TNF inhibitors (TNFi) + csDMARD combination therapy were most commonly used (39.9% and 44.9%, respectively, in the 2004–2007 period; 38.6% and 38.2%, respectively, in the 2008–2011 period; and 35.2% for both in the 2012–2015 period).

As expected those initiating biologic agents as monotherapies (54.0%) or in combination with csDMARD (49.9%), had higher disease activity than those starting csDMARD monotherapy (28.4%).

Moreover, persistence on a DMARD tended to decrease over time. Comparing the 2004–2007 and 2008–2011 and 2012–2015 periods, persistence on TNFi monotherapy was 64.3% and 52.4% and cohort 48.2%, respectively. The same was seen for biologic monotherapy (71.4% and 54.5% and 52.3%). Overall, switching between therapies was common.

Increased switching and decreased persistence appears to stem from the increased availability of treatment options in RA, but may also be the result of increased treat-to-target use amongst those aggressively managing RA.