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Second-line therapy with biological drugs in rheumatoid arthritis patients in German rheumatologist practices: a retrospective database analysis

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Abstract

The aim of the study was to assess the proportion of German patients with rheumatoid arthritis (RA) who received biological disease-modifying antirheumatic drugs (DMARDs) after initiation of conventional DMARD therapy. Patients aged 18 years or over who had initiated therapy with a conventional DMARD in a rheumatic care practice between 2009 and 2013 were included (IMS LRx database). The main outcome was the first prescription of a biological DMARD within 5 years following the index date. A multivariate Cox regression model was adopted to predict the prescription of biological DMARDs on the basis of patient characteristics. The mean age of the 137,673 patients with RA was 57.8 years (SD = 15.0). 68.3 % of the subjects were women. Most patients started their conventional DMARD therapy with methotrexate (62 %), sulfasalazine (13 %), and hydroxychloroquine (12 %). 20.7 % of the RA patients were given a biological DMARD within 5 years following the index date. Male gender was linked with a 10 % higher likelihood of biologic use whereas age decreased the odds of biological DMARD prescription by 3 % per year. Finally, leflunomide use was associated with increased odds of biologic prescription, whereas sulfasalazine and hydroxychloroquine decreased the chances of receiving biologics, as compared to methotrexate. Around 20 % of patients were being treated with biologics 5 years after prescription of conventional DMARDs. Gender, age, and initial treatment impacted the proportion of subjects treated with biological DMARDs.

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Fig. 1
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Abbreviations

DMARD:

Disease-modifying antirheumatic drug

NSAID:

Nonsteroidal anti-inflammatory drug

RA:

Rheumatoid Arthritis

TNFα:

Tumor necrosis factor α

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Authors and Affiliations

  1. Real World Evidence, IMS Health, Darmstädter Landstraße 108, 60598, Frankfurt, Germany

    Nina Gossen

  2. Department of Biology, École Normale Supérieure de Lyon, Lyon, France

    Louis Jacob

  3. Epidemiology, Real World Evidence, IMS Health, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany

    Karel Kostev

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  1. Nina Gossen
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  2. Louis Jacob
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  3. Karel Kostev
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Correspondence to Karel Kostev.

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The authors K.K., N.G., and L.J. declare that they have no conflict of interest.

Ethical approval

The article does not contain any studies with human participants performed by any of the authors. Since analysis of only anonymized data from databases was performed, this study was exempted from institutional review board oversight.

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Gossen, N., Jacob, L. & Kostev, K. Second-line therapy with biological drugs in rheumatoid arthritis patients in German rheumatologist practices: a retrospective database analysis. Rheumatol Int 36, 1113–1118 (2016). https://doi.org/10.1007/s00296-016-3448-9

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