Treatment Response, Healthcare Resource Use, and Economic Outcomes Associated With Tumor Necrosis Factor Inhibitor Cycling Versus Switching to an Advanced Therapy With Different Mechanism of Action in Rheumatoid Arthritis

OBJECTIVES: Patients with rheumatoid arthritis (RA) frequently experience non-response or intolerance to initial therapy with tumor necrosis factor inhibitors (TNFi). Guidelines recommend switching to therapies with different mechanisms of action (MoA), such as the Janus kinase inhibitor upadacitinib, over cycling to another TNFi. This study evaluated the 1-year treatment response, concomitant medication use, costs, and healthcare resource utilization associated with TNFi cycling versus MoA switching among TNFi-experienced patients with RA.

METHODS: This retrospective study used data from the Merative® MarketScan® Research Database (August 2018–April 2023). Included patients (≥18 years of age) previously treated with a single TNFi switched to a new RA treatment (ie, index treatment) between August 16, 2019–April 30, 2022, and had ≥12 months continuous enrollment pre- and post-index treatment initiation. Outcomes were assessed at 12 months post-index treatment initiation and compared between patients who switched to upadacitinib, cycled to another TNFi, or switched to other biologics.

RESULTS: At 12 months, patients who switched to upadacitinib were more likely to be treatment responders (adjusted odds ratio [aOR] [95% CI]=1.63 [1.22–2.16]) and less likely to have used glucocorticoids (aOR [95% CI]=0.72 [0.53–0.97]) versus TNFi cyclers. Patients who switched to upadacitinib versus cyclers had significantly lower numbers of rheumatologist visits (2.5 versus 3.8, P<0.001; adjusted rate ratio [aRR] [95% CI]=0.68 [0.63–0.73]) and all-cause outpatient visits (17.1 versus 19.8, P<0.001; aRR [95% CI]=0.88 [0.85–0.90]). One-year total medical costs were similar between upadacitinib switchers and TNFi cyclers. Compared with cyclers, switchers to other biologics had similar rates of treatment response and glucocorticoid use, and more rheumatologist visits, all-cause outpatient visits, and higher total medical costs.

CONCLUSIONS: Patients with RA who switched to upadacitinib had greater rates of treatment response, less glucocorticoid use, fewer rheumatologist visits, and fewer outpatient visits when compared with patients who cycled TNFi.