Currently available therapies for the treatment of Ankylosing Spondylitis (AS) target primarily the signs and symptoms of the disease; scant data exist demonstrating an impact on structural progression even for disease-modifying antirheumatic drugs (DMARDs). The European League against Rheumatism (EULAR) and the Assessments in Ankylosing Spondylitis International Society (ASAS) recommend the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, and these are often used in combination with other agents as patients progress in their treatment. For those patients who do not respond or who have an inadequate response to NSAIDs, TNF-alpha (TNF-α) inhibitors are recommended. The use of conventional DMARDs (e.g., sulfasalazine) is only recommended for patients with peripheral involvement. This report uses longitudinal patient-level claims data to understand the extent to which U.S. physicians adhere to the treatment guidelines set out by ASAS and EULAR by analyzing the use of key therapies. Both newly diagnosed and recently treated AS patient cohorts are examined. Among the newly diagnosed patients, we provide 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 combination therapy. Among recently treated patients, we quantify a drug’s source of business compared with its competitors, and detail 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 17% of AS patients begin treatment with a DMARD within a year of their initial diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year? 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: Nearly three-quarters of recently treated patients used a TNF-α inhibitor. Which specific drugs garner the most patient share for recently treated AS patients? When do patients progress from one therapy to the next in AS, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming through new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal that the preferred TNF-alpha inhibitors in each line of therapy have evolved since their approval for AS. 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 AS?

Scope:

Primary patient-level data: Quantitative findings from our analysis of data covering approximately 40 million lives providing 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 with claims that are less than six months old at the time of publication.

Patient Sample:

Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for AS (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic code 720.0) during the study period.

Quantified lines of therapy analysis showing 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 one year of diagnosis.

- Patient flowchart through one year 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.


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