Skip to main content

Advertisement

SpringerLink
Log in

Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence

  • Original Article - Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3 years showed that GLM had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider–patient–payer–drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Blum MA, Koo D, Doshi JA (2011) Measurement and rates of persistence with and adherence to biologics for rheumatoid arthritis: a systematic review. Clin Ther 33(7):901–913

    Article  PubMed  Google Scholar 

  2. Tang B et al (2008) Treatment persistence with adalimumab, etanercept, or infliximab in combination with methotrexate and the effects on health care costs in patients with rheumatoid arthritis. Clin Ther 30(7):1375–1384

    Article  CAS  PubMed  Google Scholar 

  3. Baser O, Ganguli A, Roy S, Xie L, Cifaldi M (2015) Impact of switching from an initial tumor necrosis factor inhibitor on health care resource utilization and costs among patients with rheumatoid arthritis. Clin Ther 37(7):1454–1465. doi:10.1016/j.clinthera.2015.04.012

    Article  PubMed  Google Scholar 

  4. Meissner B et al (2014) Switching of biologic disease modifying anti-rheumatic drugs in patients with rheumatoid arthritis in a real world setting. J Med Econ 17(4):259–265

    Article  PubMed  Google Scholar 

  5. Kodningskvalitet i patientregistret. The National Board of Health and Welfare (Socialstyrelsen). http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18082/2010-6-27.pdf. Accessed 23 June 2015

  6. Causes of Death 2013. The National Board of Health and Welfare (Socialstyrelsen). https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/19736/2015-2-42.pdf. Accessed 20 Aug 2015

  7. Pharmaceuticals—statistics for 2014. The National Board of Health and Welfare (Socialstyrelsen). https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/19768/2015-3-17.pdf. Accessed 20 Aug 2015

  8. Cramer JA et al (2008) Medication compliance and persistence: terminology and definitions. Value Health 11(1):44–47

    Article  PubMed  Google Scholar 

  9. Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  10. D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17(19):2265–2281

    Article  PubMed  Google Scholar 

  11. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70(1):41–55

    Article  Google Scholar 

  12. Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ho DE (2007) Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Polit Anal 15(3):199–236

    Article  Google Scholar 

  14. Imai K, King G, Stuart EA (2008) Misunderstandings between experimentalists and observationalists about causal inference. J R Stat Soc Series A 171(Part 2):481–502

    Article  Google Scholar 

  15. Rosenbaum PR, Rubin DB (1985) Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 39(1):33–38

    Google Scholar 

  16. Wu E, Chen L, Birnbaum H et al (2008) Retrospective claims data analysis of dosage adjustment patterns of TNF antagonists among patients with RA. Curr Med Res Opin 24:2229–2240

    Article  CAS  PubMed  Google Scholar 

  17. Khalil H, Tahami A (2012) Golimumab drug utilization patterns in Canada—higher retention rate in golimumab treated rheumatoid patients arthritis patients compared to etanercept and adalimumab [Abstract]. Arthritis Rheum 64(Suppl 10):497. doi:10.1002/art.38232

    Google Scholar 

  18. Svedbom A et al (2015) Treatment patterns with topicals, traditional systemics and biologics in psoriasis—a Swedish database analysis. J Eur Acad Dermatol Venereol 29(2):215–223

    Article  CAS  PubMed  Google Scholar 

  19. Neovius M et al (2015) Drug survival on TNF inhibitors in patients with rheumatoid arthritis comparison of adalimumab, etanercept and infliximab. Ann Rheum Dis 74(2):354–360

    Article  CAS  PubMed  Google Scholar 

  20. Chatzidionysiou K, Kristensen LE, Eriksson J, Askling J, van Vollenhoven R, For The Artis G (2015) Effectiveness and survival-on-drug of certolizumab pegol in rheumatoid arthritis in clinical practice: results from the national Swedish register. Scand J Rheumatol 44(6):431–437. doi:10.3109/03009742.2015.1026840

    Article  CAS  PubMed  Google Scholar 

  21. Saevarsdottir S, Santacatterina M, Stawiarz L, Turesson C, Forsblad H, Jacobsson LTH, Lindblad S (2013) Drug survival in patients receiving Golimumab treatment 2010–2013. Results from the Swedish Rheumatology Quality Register [abstract]. Arthritis Rheum 65(Suppl 10):1514. doi:10.1002/art.2013.65.issue-s10

    Google Scholar 

Download references

Acknowledgments

This study was funded by Merck & Co., Inc., Rahway, NJ, USA. The sponsor was involved with the writing, study design, analysis, and interpretation of data.

Author information

Authors and Affiliations

  1. Mapi Group, Stockholm, Sweden

    Johan Dalén & Axel Svedbom

  2. Department of Medicine, Karolinska Institutet, Solna, Sweden

    Axel Svedbom

  3. Merck & Co., Inc., 126 E. Lincoln Avenue, Rahway, NJ, 07065, USA

    Christopher M. Black, Ramon Lyu, Qian Ding, Shiva Sajjan & Sumesh Kachroo

  4. MSD Inovativna Zdravilla, Ljubljana, Slovenia

    Vasilisa Sazonov

Authors
  1. Johan Dalén
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Axel Svedbom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher M. Black
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ramon Lyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qian Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shiva Sajjan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vasilisa Sazonov
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sumesh Kachroo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sumesh Kachroo.

Ethics declarations

Conflict of interest

AS and JD are consultants to Merck through their employment at Mapi Group. Mapi Group has received funding from several pharmaceutical companies involved in marketing products for treatment of immune-mediated rheumatic disease. SK, SS, and CMB are employees of Merck & Co., Inc. RL and QD are former employees of Merck & Co., Inc. VS is an employee of MSD inovativna zdravilla, a subsidiary of Merck & Co., Inc.

Electronic supplementary material

Below is the link to the electronic supplementary material.

E-Supplement 1

Sequential sample selection (DOCX 19 kb)

Supplementary material 2 (DOCX 35 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dalén, J., Svedbom, A., Black, C.M. et al. Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence. Rheumatol Int 36, 987–995 (2016). https://doi.org/10.1007/s00296-016-3423-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-016-3423-5

Keywords

Search

Navigation