Corrona RA registry reveals more drug switching, less time spent on given therapy
Data from an independent, prospective, observational registry reveals increased drug switching and less time spent on a given therapy among patients with rheumatoid arthritis from 2012 to 2015, according to researchers.
“Although the American College of Rheumatology (ACR) guidelines recommend [conventional synthetic disease-modifying antirheumatic drugs (csDMARDs)] as the first line of treatment, many rheumatologists have observed in their real-world practices that these recommendations are not always practical,” Philip J. Mease, MD, of Swedish Medical Center and the University of Washington, in Seattle, and colleagues wrote in Arthritis Research & Therapy. “This is primarily due to contraindications and the negative impact csDMARDs can have on a patient’s quality of life such as drug-induced intolerance or side effects, which then often leads to treatment discontinuation at the patient’s request.
“Furthermore, in analyses of observational registries, approximately one-third of all patients with RA were already receiving biologic monotherapies, suggesting that physicians were utilizing a biologic monotherapy approach for many of their patients,” they added. “Given the observed differences in the guideline recommendations and real-world practices, describing the evolving treatment patterns in patients with RA is essential to understand how treatment decisions are being made to optimize patient care.”
To analyze treatment patterns among patients with RA on newly initiated biologic or nonbiologic drugs over time, Mease and colleagues conducted a retrospective, cohort study of adults enrolled in the Corrona RA registry. According to the researchers, the Corrona registry is an independent, prospective observational cohort of patients with RA.
For this study, Mease and colleagues included patients who had started therapy with either conventional synthetic DMARD monotherapy, biologic monotherapy, or a combination of the two, between Jan. 1, 2004, and Dec. 31, 2015. Patients were also required to have at least 6 months of follow-up time since their first index therapy dose and at least one follow-up visit. In all, 8,027 patients from the registry were included. For their analysis, the researchers set their time periods of interest based on the year of index therapy initiation — 2004 to 2007, 2008 to 2011 and 2012 to 2015.
According to the researchers, conventional synthetic DMARD monotherapy and combination with a TNF inhibitor and a conventional synthetic DMARD were the most common initial strategies in the registry. These strategies accounted for 39.9% and 44.9% of patients, respectively, in the 2004 to 2007 period; 38.6% and 38.2%, respectively, in the 2008 to 2011 period; and 35.2% for each in the 2012 to 2015 period.
At therapy initiation, a higher proportion of patients who started other biologics, including 54% of those on monotherapy and 49.9% of those on combination therapy with a conventional synthetic DMARD, demonstrated high disease activity, compared with the 28.4% of patients who initiated monotherapy with a conventional synthetic DMARD.
For 2012 to 2015 versus the 2004 to 2007 and 2008 to 2011 periods, persistence with a given therapy decreased among the TNF-inhibitor monotherapy group — 48.2% compared with 64.3% and 52.4% — as well as the other biologic monotherapy cohort — 52.3% compared with 71.4% and 54.5% — over 12months. Switching from one drug to another was also common in the Corrona RA registry, the researchers wrote.
“Persistence on different types of therapy diminished during the most recent period — 2012 to 2015 — presumably because clinicians and patients are more focused on treating to a target of remission or low disease activity,” Mease told Healio Rheumatology. “In prior periods of evaluation, there were fewer drugs and drug classes to choose from and switch between, so we tended to hang on longer to the patient’s current therapy, even if the patient had not quite reached a state of low or inactive disease.
“Nowadays there are more drugs and drug classes to choose from, so we are less anxious, if the patient has not reached a therapeutic target, to try jumping to a new medication,” he added. “This is reflected in this analysis. Another key takeaway is the relatively high percentage of patients — between a third and a half — who are using biologics and targeted synthetic medications as monotherapy, including TNF inhibitors, without methotrexate background. This, despite the findings from older studies that show better effectiveness if biologics are using in combination with methotrexate.”
According to Mease, this reflects an interest among clinicians and patients in using advanced medications as monotherapy without the side effects and lifestyle restrictions that may accompany MTX use.
“The observation that monotherapy-treated patient persist on their medication suggests that this approach is efficacious,” he said. “Clinicians and patients are increasingly seeking ‘higher ground,’ i.e. states of remission or low disease activity as new therapies emerge for patients. It is ok to use a monotherapy approach in treating RA.”