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High Drug Switching and Low Persistence in Rheumatoid Arthritis

Sep 13, 2021 12:58 pm

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.

The author has no conflicts of interest to disclose related to this subject

Rheumatologists’ Comments

Bobo Tanner MD

| Sep 14, 2021 4:31 pm

Jack , We had a different outcome using Pharm Ds In our hospital system. We looked at ~700 RA pts. and found that using an integrated specialty pharmacy demonstrated high medication
adherence and persistence and low
rates of switching and cycling.
Our findings support evidence that
integrated health system specialty
pharmacies help patients overcome
barriers to medication adherence to
persist on therapy.
J Manag Care Spec Pharm.

Dr. Tanner... very cool interjection! There is a better way and your use of an integrated specialty pharmacy would be a real plus to Drs. and pts alike!

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