Dallas, TX—Although abatacept is frequently used in the second-line or later treatment of patients with rheumatoid arthritis (RA) whose disease is unresponsive to ≥1 biologic disease-modifying antirheumatic drugs (bDMARDs), this agent can also be used in the first-line setting. A clinical benefit has recently been demonstrated in patients with RA who initiated abatacept earlier compared with those who initiated the drug as second-line treatment. However, because of recent clinical and molecular profiling, it has been posited that certain patient populations may not benefit from this approach, including those categorized as having early rapidly progressing RA (eRPRA).
In response to this suggestion, Andrew J. Klink, PhD, MPH, Manager, Health Economics and Outcomes Research, Cardinal Health Specialty Solutions, Dublin, OH, and colleagues sought to evaluate the viability of identifying patients with eRPRA, and to characterize healthcare resource use among these patients treated with different bDMARDs (ie, anti–TNF-alpha or abatacept). They carried out a retrospective, observational, long-term chart review, and reported their results in a poster presented at the Academy of Managed Care Pharmacy Nexus 2017 Conference.
Dr Klink and colleagues collected data on patient characteristics and healthcare resource use for 104 patients receiving an anti–TNF-alpha and 34 patients receiving abatacept who met criteria for eRPRA classification before receiving their first treatment with a bDMARD.
For patients receiving an anti–TNF-alpha or abatacept, mean age at RA diagnosis was 47.6 years and 48.7 years, respectively, and time from diagnosis to eRPRA identification was 5.3 months and 4.8 months, respectively.
At the time of treatment initiation, patients who received an anti–TNF-alpha or abatacept had mean swollen joint counts of 7.3 and 8.0, respectively; tender joint counts of 10.0 and 12.1, respectively; erythrocyte sedimentation rates of 51.0 mm/hr and 52.3 mm/hr, respectively; C-reactive protein levels of 6.3 mg/L and 6.0 mg/L, respectively; and 1.0 and 2.1 bony erosions, respectively.
Hospitalizations (87% vs 82%), emergency department visits (88% vs 85%), magnetic resonance imaging (88% vs 74%), ultrasounds (88% vs 74%), and x-rays (98% vs 88%) occurred more frequently in patients with eRPRA who received an anti–TNF-alpha therapy than in those who received abatacept during the first 6 months of bDMARD treatment.
Dr Klink and colleagues asserted that, although the characterization is poorly defined in clinical practice, patients can be identified as having eRPRA. The results of their study also pointed to a decrease in healthcare utilization among patients in this subset who were treated with abatacept compared with those who were treated with an anti–TNF-alpha. However, they stressed the need for further research into the differences among patients with eRPRA receiving these agents.
“Despite having greater disease severity at start of a bDMARD, patients with eRPRA treated with abatacept tended to have lower HRU [healthcare resource use] than those treated with an anti-TNF-α [alpha]. Comparisons are warranted on a greater number of eRPRA patients to identify statistically and clinically meaningful differences in patient characteristics and HRU between those treated with a TNF-α inhibitor or abatacept,” Dr Klink and colleagues concluded.