Prescribing Trends of Biologic Disease-Modifying Anti-rheumatic Drugs Using a Claims Database from 6 Million People in Japan
Authors: Atsushi Hirata, Ryosuke Ota, Takeo Hata, Takeshi Hamada, Masami Nishihara, Kazuhisa Uchiyama & Takahiro Katsumata
Background and Objective
Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are used either when conventional synthetic DMARDs are ineffective or when disease activity is high and with poor prognostic factors, based on various clinical guidelines. The purpose of this study was to investigate the prescribing trends of bDMARDs for patients with rheumatoid arthritis in Japan, and to clarify whether the pharmacological therapy of bDMARDs is administered based on guidelines.
We conducted a descriptive epidemiological study from 2012 to 2018 using the JMDC Claims Database, a nationwide claims database, and described the annual changes based on the number of patients prescribed bDMARDs. Anti-rheumatic drugs were identified based on the Anatomical Therapeutic Chemical codes, including methotrexate, glucocorticoids, non-steroidal anti-inflammatory drugs and bDMARDs.
From the database including 6,862,244 people, the data of 6407 patients with rheumatoid arthritis were extracted. The present study demonstrated that the proportion of patients prescribed bDMARDs was 1.0 per 1000 people, with those aged ≥ 65 years being the most common age group. The proportion of patients with rheumatoid arthritis who were prescribed bDMARDs increased significantly over time (p < 0.0001). Additionally, the concomitant proportions of methotrexate (p < 0.0001), non-steroidal anti-inflammatory drugs (p < 0.0001) and glucocorticoids (p = 0.0001) prescribed with bDMARDs decreased significantly over time.
The increase in bDMARD monotherapy may be attributed to the new bDMARDs that have been launched sequentially; furthermore, physicians have come to recognise monotherapy as the mainstay of treatment. Future studies must accumulate evidence on the long-term efficacy and safety of bDMARDs.
This study investigated the prescribing trends of biologic disease-modifying anti-rheumatic drugs (bDMARDs) using a relatively large sample size in Japan and to clarify whether the pharmacological therapy of bDMARDs is performed based on clinical guidelines.
The present study shows that the use of bDMARDs is increasing in accordance with the guidelines; on the contrary, the concomitant proportions of methotrexate, non-steroidal anti-inflammatory drugs and glucocorticoids with bDMARDs decreased significantly over time.
This study revealed that monotherapy of bDMARDs for rheumatoid arthritis is progressing and being launched sequentially.