Predictors of Low Disease Activity/ Remission Amongst Rheumatoid Arthritis Patients Experiencing Inadequate Response to Biologic/ Targeted Synthetic Disease-Modifying Antirheumatic Drugs
Author(s)
Chandrasekar Gopalakrishnan, MD, MPH1, Kathryn Starzyk, BA, MSc1, Luis Rangel, MS1, Eric Hanson, MD2, Michael Behling, MPH2, Andrea Cohee, RN, PhD2, Beth Mitchell, MPH2, Russel Thomas Burge, PhD2.
1OM1, Inc., Boston, MA, USA, 2Eli Lilly and Company, Indianapolis, IN, USA.
1OM1, Inc., Boston, MA, USA, 2Eli Lilly and Company, Indianapolis, IN, USA.
OBJECTIVES: Despite availability of several disease-modifying antirheumatic drugs (DMARDs), many patients with rheumatoid arthritis (RA) fail to achieve low-disease activity (LDA)/remission. The study’s purpose was to identify predictors of treatment response amongst patients who previously experienced inadequate response to a biologic (b) or targeted synthetic (ts) DMARD
METHODS: Data for this new user cohort study were derived from OM1 PremiOM™ RA (OM1, Boston, MA), a multisource real-world dataset with linked claims and EHR data on RA patients in the US. Study population included adult moderate-to-severe RA patients initiating a b/tsDMARD between January 2013 to June 2024 and had used a different b/tsDMARD in the year prior. Primary outcome was LDA/remission [Clinical Disease Activity Index (CDAI) score ≤ 10.0] measured at 6 months post-initiation. Log-binomial regression was used to model the probability of achieving LDA/remission with baseline characteristics measured during the 365 days prior to treatment initiation as predictors. Predictors included demographics, insurance type, obesity, comorbidities, seropositivity, CRP level, and prior medication use.
RESULTS: The final eligible cohort was comprised of 8,681 patients [mean age in years (standard deviation) = 58.4 (12.8)]. At baseline, the mean (SD) CDAI was 24.3 (10.9) and after 6 months of follow-up, the mean CDAI was 17.6 (12.0) with 31.0% of patients achieving LDA/remission. Multivariable analyses demonstrated that patients with obesity (RR=0.88; 95% CI=0.82-0.94), osteoporosis (RR=0.90; 95% CI=0.81-0.99), COPD (RR=0.84; 95% CI=0.73-0.98), fibromyalgia (RR=0.74; 95% CI=0.67-0.82), higher baseline CDAI scores (RR=0.97; 95% CI=0.96-0.97), or initiated bDMARDs (vs. tsDMARDs) (RR=0.92; 95% CI=0.86-0.98) were less likely to achieve LDA/remission at 6 months.
CONCLUSIONS: In this large real-world study of moderate-to-severe RA patients with prior inadequate response to b/tsDMARDs, over two-thirds of patients who started new b/tsDMARDs failed to achieve LDA/remission after 6 months of follow-up. Several baseline comorbidities were identified as statistically significant predictors of poor treatment response.
METHODS: Data for this new user cohort study were derived from OM1 PremiOM™ RA (OM1, Boston, MA), a multisource real-world dataset with linked claims and EHR data on RA patients in the US. Study population included adult moderate-to-severe RA patients initiating a b/tsDMARD between January 2013 to June 2024 and had used a different b/tsDMARD in the year prior. Primary outcome was LDA/remission [Clinical Disease Activity Index (CDAI) score ≤ 10.0] measured at 6 months post-initiation. Log-binomial regression was used to model the probability of achieving LDA/remission with baseline characteristics measured during the 365 days prior to treatment initiation as predictors. Predictors included demographics, insurance type, obesity, comorbidities, seropositivity, CRP level, and prior medication use.
RESULTS: The final eligible cohort was comprised of 8,681 patients [mean age in years (standard deviation) = 58.4 (12.8)]. At baseline, the mean (SD) CDAI was 24.3 (10.9) and after 6 months of follow-up, the mean CDAI was 17.6 (12.0) with 31.0% of patients achieving LDA/remission. Multivariable analyses demonstrated that patients with obesity (RR=0.88; 95% CI=0.82-0.94), osteoporosis (RR=0.90; 95% CI=0.81-0.99), COPD (RR=0.84; 95% CI=0.73-0.98), fibromyalgia (RR=0.74; 95% CI=0.67-0.82), higher baseline CDAI scores (RR=0.97; 95% CI=0.96-0.97), or initiated bDMARDs (vs. tsDMARDs) (RR=0.92; 95% CI=0.86-0.98) were less likely to achieve LDA/remission at 6 months.
CONCLUSIONS: In this large real-world study of moderate-to-severe RA patients with prior inadequate response to b/tsDMARDs, over two-thirds of patients who started new b/tsDMARDs failed to achieve LDA/remission after 6 months of follow-up. Several baseline comorbidities were identified as statistically significant predictors of poor treatment response.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO132
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), STA: Biologics & Biosimilars