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Examining Time to Initiation of Biologic Disease-modifying Antirheumatic Drugs and Medication Adherence and Persistence Among Texas Medicaid Recipients With Rheumatoid Arthritis

      Abstract

      Purpose

      Little is known about the transition from nonbiologic disease-modifying antirheumatic drugs (DMARDs) to biologic DMARDs or about individual nonbiologic DMARD use patterns among patients with rheumatoid arthritis (RA). This study examined time to initiation of biologic DMARDs and nonbiologic DMARD medication adherence and persistence among Texas Medicaid recipients with RA taking nonbiologic DMARDs.

      Methods

      In this retrospective study (July 1, 2003–December 31, 2010) of the Texas Medicaid database, patients were aged 18 to 62 years at index, were diagnosed with RA (International Classification of Diseases, Ninth Revision, Clinical Modification, code 714.xx), had no claims for nonbiologic or biologic DMARDs in the preindex period, and had a minimum of 2 prescription claims for the same nonbiologic DMARD in the postindex period. Kaplan-Meier survival analysis and log-rank tests were used to compare time to initiation of biologic DMARDs according to nonbiologic DMARD type and therapy. Adherence and persistence were examined according to nonbiologic type and therapy by using ANOVA models and χ2, Duncan, and t tests.

      Findings

      On average, patients were 47.9 (±10.4) years of age, mostly female (89.1%) and Hispanic (55.2%). Methotrexate (MTX) and leflunomide (LEF) users took the shortest time to initiate biologic DMARDs (207 [190] days and 188 [205] days, respectively). LEF users had the highest mean adherence of 37.5% (27.5%), which was similar to MTX users (35.7% [26.9%]), whereas dual-therapy users had the lowest mean adherence at 17.1% (14.4%). Sulfasalazine users (108 [121] days) had the lowest persistence, whereas LEF (227 [231] days) and MTX (211 [222] days) users had the longest persistence. Nonbiologic DMARD monotherapy users were more adherent than dual-therapy users (32.6% [25.8%] vs 17.1% [14.4%]).

      Implications

      These results should be interpreted in light of some study limitations, such as using proportion of days covered as a proxy for adherence, not having clinical data to control for RA severity, and lack of generalizability to all US populations. Given the study findings, both clinicians and other decision makers may want to investigate the potential driving factors of initiation of biologic DMARDs to provide effective RA management and consider patient education programs to enhance medication adherence and persistence to RA medications.

      Key words

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      References

        • Singh J.A.
        • Furst D.E.
        • Bharat A.
        • et al.
        2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis.
        Arthritis Care Res (Hoboken). 2012; 64: 625-639
        • Smolen J.S.
        • Landewe R.
        • Breedveld F.C.
        • et al.
        EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update.
        Ann Rheum Dis. 2014; 73: 492-509
      1. Biologic DMARDs. (2014). Retrieved August 2013 [electronic version], from Micromedex, UT-Austin Library edition.
        • Yazici Y.
        • Shi N.
        • John A.
        Utilization of biologic agents in rheumatoid arthritis in the United States: analysis of prescribing patterns in 16,752 newly diagnosed patients and patients new to biologic therapy.
        Bull NYU Hosp Jt Dis. 2008; 66: 77-85
        • Soderlin M.K.
        • Geborek P.
        Changing pattern in the prescription of biological treatment in rheumatoid arthritis. A 7-year follow-up of 1839 patients in southern Sweden.
        Ann Rheum Dis. 2008; 67: 37-42
        • Taal E.
        • Rasker J.J.
        • Seydel E.R.
        • Wiegman O.
        Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis.
        Patient Educ Couns. 1993; 20(2–3): 63-76
        • Salt E.
        • Frazier S.K.
        Adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a narrative review of the literature.
        Orthop Nurs. 2010; 29(4): 260-275
        • Contreras-Yanez I.
        • Ponce De Leon S.
        • Cabiedes J.
        • Rull-Gabayet M.
        • Pascual-Ramos V.
        Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs.
        Am J Med Sci. 2010; 340(4): 282-290
        • van den Bemt B.J.F.
        • Zwikker H.E.
        • van den Ende C.H.M.
        Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature.
        Expert Rev Clin Immunol. 2012; 8(22607180): 337-351
        • Grijalva C.G.
        • Chung C.P.
        • Arbogast P.G.
        • et al.
        Assessment of adherence to and persistence on disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis.
        Med Care. 2007; 45: 66-76
        • de Klerk E.
        • van der Heijde D.
        • Landewe R.
        • et al.
        Patient compliance in rheumatoid arthritis, polymyalgia rheumatica, and gout.
        J Rheumatol. 2003; 30: 44-54
        • Agarwal S.
        • Zaman T.
        • Handa R.
        Retention rates of disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis.
        Singapore Med J. 2009; 50: 686-692
        • Aletaha D.
        • Stamm T.
        • Kapral T.
        • et al.
        Survival and effectiveness of leflunomide compared with methotrexate and sulfasalazine in rheumatoid arthritis: a matched observational study.
        Ann Rheum Dis. 2003; 62: 944-951
        • Grove M.L.
        • Hassell A.B.
        • Hay E.M.
        • Shadforth M.F.
        Adverse reactions to disease-modifying anti-rheumatic drugs in clinical practice.
        QJM. 2001; 94: 309-319
        • Aletaha D.
        • Smolen J.S.
        Effectiveness profiles and dose dependent retention of traditional disease modifying antirheumatic drugs for rheumatoid arthritis. An observational study.
        J Rheumatol. 2002; 29: 1631-1638
        • de Thurah A.
        • Norgaard M.
        • Johansen M.B.
        • Stengaard-Pedersen K.
        Methotrexate compliance among patients with rheumatoid arthritis: the influence of disease activity, disease duration, and co-morbidity in a 10-year longitudinal study.
        Scand J Rheumatol. 2010; 39: 197-205
        • Grijalva C.G.
        • Kaltenbach L.
        • Arbogast P.G.
        • et al.
        Adherence to disease-modifying antirheumatic drugs and the effects of exposure misclassification on the risk of hospital admission.
        Arthritis Care Res (Hoboken). 2010; 62: 730-734
        • Brus H.
        • van de Laar M.
        • Taal E.
        • et al.
        Determinants of compliance with medication in patients with rheumatoid arthritis: the importance of self-efficacy expectations.
        Patient Educ Couns. 1999; 36: 57-64
        • Wolfe F.
        • Michaud K.
        • Stephenson B.
        • Doyle J.
        Toward a definition and method of assessment of treatment failure and treatment effectiveness: the case of leflunomide versus methotrexate.
        J Rheumatol. 2003; 30: 1725-1732
        • Galindo-Rodriguez G.
        • Avina-Zubieta J.A.
        • Russell A.S.
        • Suarez-Almazor M.E.
        Disappointing longterm results with disease modifying antirheumatic drugs. A practice based study.
        J Rheumatol. 1999; 26: 2337-2343
        • Maetzel A.
        • Wong A.
        • Strand V.
        • et al.
        Meta-analysis of treatment termination rates among rheumatoid arthritis patients receiving disease-modifying anti-rheumatic drugs.
        Rheumatology (Oxford). 2000; 39: 975-981