Washington, DC—In recent decades, the increased use of biologic agents has changed the way patients with rheumatoid arthritis are treated. At the 2016 Annual Meeting of the American College of Rheumatology, James R. O’Dell, MD, Bruce Professor and Vice Chair, Internal Medicine, and Chief Division of Rheumatology, University of Nebraska Medical Center, Omaha, discussed the impact these advances have on the management of rheumatoid arthritis.
A recent study analyzed the use of biologics as initial disease-modifying antirheumatic drug (DMARD) treatment, and the use of subcutaneously administered methotrexate in patients whose disease was not adequately managed with oral methotrexate.
The investigators used Symphony Health Solutions’ anonymized patient-level claims data, which covers 92% of all prescription drugs dispensed in the United States and approximately 274 million patients, to identify patients via International Classification of Diseases, Ninth Revision codes 714.0 and 714.30 who were treated in 2009 or 2012 with a biologic agent as their initial DMARD and those who were treated with subcutaneously administered methotrexate after oral methotrexate. Data from the year before treatment started through 2014 were analyzed.
There were 48,910 patients in the 2009 cohort and 107,536 in the 2012 cohort. In the 2009 cohort, 13,270 (27.1%) patients started treatment with a biologic compared with 38,209 (35.6%) patients in the 2012 cohort (P <.0001). There did not appear to be any differences in clinical characteristics or baseline demographics between these 2 cohorts.
Patients in the 2012 cohort used subcutaneously administered methotrexate at a significantly higher rate than the 2009 cohort. Of the 35,640 patients started with oral methotrexate in the 2009 cohort, 20,041 (56.2%) of them changed to another treatment within 5 years, with 2513 (12.5%) switching to subcutaneously administered methotrexate. Of the 69,327 patients started on oral methotrexate in the 2012 cohort, 18,989 (27.4%) changed to another treatment within 2 years, with 3976 (20.9%) switching to subcutaneously administered methotrexate.
Dr O’Dell and colleagues noticed 3 significant trends emerging in the treatment of rheumatoid arthritis. First, nonmethotrexate DMARDs are being used more frequently before starting patients on treatment with a biologic. In addition, an increasing number of patients who have not previously used conventional DMARDs are using biologics. Lastly, there is a nonoptimal increase in the use of subcutaneously administered methotrexate after using oral methotrexate.