Rheumatoid Arthritis | Treatment Algorithms | Claims Data Analysis | US | 2014

Publish date: December 2014

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For the estimated million people in the United States with rheumatoid arthritis (RA), there are multiple disease modifying anti-rheumatic drugs (DMARDs) available for reducing the signs and symptoms of disease and halting the destructive course of disease to prevent debilitating joint damage. The American College of Rheumatology (ACR) guidelines recommend initiating RA therapy with the prescription of conventional DMARDs, which have lower prices and long-established efficacy and safety, before moving on to biological agents, including TNF-α inhibitors, selective costimulation modulators, B-cell inhibitors, and Interleukin-6 inhibitors. Using national patient-level claims data, this report analyzes physician adherence to treatment guidelines by exploring the use of key therapies in the newly diagnosed and recently treated RA patient populations. Among the newly diagnosed patients, our report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. Among recently treated patients, our report quantifies a drug’s source of business compared with its competitors, and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Approximately 47% of RA patients begin treatment with a key therapy within three years of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first three years? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: Consistent with historical treatment patterns, the conventional DMARDs continue to capture the majority of recently treated patient prescriptions. Which specific drugs garner the most patient share for recently treated RA patients? When do patients progress from one therapy to the next in RA, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal relatively consistent use patterns of key therapies among recently treated patients; use of TNF-α inhibitors and other non-TNF biologics for RA increases in the later lines of therapy. Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs for RA?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet, and presents claims that are between 6-12 months old at time of publication.

Patient Sample: Patients who are continuously enrolled for the complete four-year study period must meet the following condition: at least two claims with a diagnosis code for RA, other specified inflammatory polyarthropathy, unspecified inflammatory polyarthropathy (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 714.0, 714.89, 714.9) during the study period. Patients must be aged 18 or older to be included in our study.

Quantified lines of therapy analyses show exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly Diagnosed Patients:

- Patient share by drug class and key products across three lines of therapy, within three years of diagnosis.

- Patient flowcharts through three years of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trends in patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.