Predictors of Effectiveness of Biologic and Targeted Synthetic Disease Modifying Antirheumatic Drugs in the Treatment of Rheumatoid Arthritis
Author(s)
Natália Dias Brandão, MSc1, Marina Garcia, PhD2, Bárbara Rodrigues Alvernaz Santos, MSc2, Francisco de Assis Acurcio, PhD2, Augusto Afonso Guerra Júnior, PhD2, Juliana Alvares, PhD3.
1UFMG, BELO HORIZONTE, Brazil, 2CCATES/UFMG, Belo Horizonte, Brazil, 3CCATES/UFMG, BELO HORIZONTE, Brazil.
1UFMG, BELO HORIZONTE, Brazil, 2CCATES/UFMG, Belo Horizonte, Brazil, 3CCATES/UFMG, BELO HORIZONTE, Brazil.
OBJECTIVES: Biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) are recommended for treating rheumatoid arthritis (RA) when conventional synthetic DMARDs have been ineffective. Access to anti-TNF (adalimumab, etanercept, infliximab and certolizumab pegol), non-anti-TNF bDMARDs (tocilizumab and abatacept) and tsDMARD (tofacitinib - janus kinase inhibitors - JAKi) requires an administrative approval and dispensing process in the Brazilian Public Health System. The aim was to assess the predictors of the effectiveness of b/tsDMARDs. Treatment persistence was used as a proxy for effectiveness.
METHODS: The cohort included patients with RA who requested their first b/tsDMARD between June 2018 and September 2022. It was constructed from drug dispensing records, clinical and sociodemographic data. Patients were followed up for 18 months. The association between variables and treatment persistence was assessed using linear regression. A significance level of 20% was adopted for the univariate analysis and 5% for the multivariate analysis.
RESULTS: Among 749 patients, 85% were women, 33.5% white, with a mean age 55.4 years. 69.5% used anti-TNF, 7.3% non-anti-TNF, and 23.2% iJAK. And 83% were associated with a scDMARD. Non-anti-TNF group had less persistence. The discontinuation, switching and persistence rates were 15.2%, 36.3% and 48.5%, respectively. Univariate analysis showed that an age of 30 years or under was a predictor of effectiveness (p = 0.025), while the use of non-anti-TNF drugs (p = 0.029) and associated scDMARDs (p = 0.113) were considered predictors of non-effectiveness. In the multivariate analysis, the age remained as a predictor variable and the use of non-anti-TNF drugs (p=0.024) was a non-predictor variable.
CONCLUSIONS: Overall, anti-TNF and JAKi groups were more effective. Younger patients also tend to respond better to treatment. This knowledge can help optimise the use of public resources. This includes the assessment of possible disinvestments in health technologies and the development of public policies to improve access to treatments.
METHODS: The cohort included patients with RA who requested their first b/tsDMARD between June 2018 and September 2022. It was constructed from drug dispensing records, clinical and sociodemographic data. Patients were followed up for 18 months. The association between variables and treatment persistence was assessed using linear regression. A significance level of 20% was adopted for the univariate analysis and 5% for the multivariate analysis.
RESULTS: Among 749 patients, 85% were women, 33.5% white, with a mean age 55.4 years. 69.5% used anti-TNF, 7.3% non-anti-TNF, and 23.2% iJAK. And 83% were associated with a scDMARD. Non-anti-TNF group had less persistence. The discontinuation, switching and persistence rates were 15.2%, 36.3% and 48.5%, respectively. Univariate analysis showed that an age of 30 years or under was a predictor of effectiveness (p = 0.025), while the use of non-anti-TNF drugs (p = 0.029) and associated scDMARDs (p = 0.113) were considered predictors of non-effectiveness. In the multivariate analysis, the age remained as a predictor variable and the use of non-anti-TNF drugs (p=0.024) was a non-predictor variable.
CONCLUSIONS: Overall, anti-TNF and JAKi groups were more effective. Younger patients also tend to respond better to treatment. This knowledge can help optimise the use of public resources. This includes the assessment of possible disinvestments in health technologies and the development of public policies to improve access to treatments.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH185
Topic
Epidemiology & Public Health, Health Technology Assessment, Real World Data & Information Systems
Topic Subcategory
Public Health, Safety & Pharmacoepidemiology
Disease
Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)