OBJECTIVES : ACR guidelines recommend starting RA treatment with conventional-synthetic (cs)DMARD monotherapy. If disease activity remains moderate or high, the guidelines recommend adding or switching to another csDMARD, biologic (b)DMARD, or janus kinase inhibitors (JAKi) for established RA. In early (<6 months) RA, the guidelines recommend tumor necrosis factor inhibitors (TNFi)/TNFi+methotrexate (MTX) over JAKi/JAKi+MTX. This study aimed to investigate treatment patterns and duration in csDMARD IR patients.

METHODS : In fully-adjudicated commercial medical and pharmacy health insurance claims database with ~40 million lives annually), adult RA patients (≥2 RA diagnoses ≥30 days apart) who started csDMARD (1/1/2012—3/31/2017) and then switched to or added another DMARD (index date, ID) were selected. Real world treatment patterns of patients with ≥1-year continuous enrollment before (baseline) and after ID were assessed.

RESULTS : Among 25,104 csDMARD initiators, 10,091 (40%) demonstrated IR, and 7,816 met all the selection criteria (median age 54 years, 26% male). The baseline csDMARD treatment lasted for a median of 4.3 months and mostly comprised of monotherapy (96%). Upon treatment regimen change, 62% (n=4,869) initiated combination therapy (32% csDMARD+csDMARD, 28% csDMARD+TNFi, 1.4% csDMARD+other bDMARD, 0.5% csDMARD+JAKi) and 38% initiated monotherapy (27% on csDMARD, 10% TNFi, 0.7% other bDMARD, 0.5% JAKi). Post-switch, the median treatment duration was longer for combination than monotherapy: 13.7 vs. 5.2 months (p<0.001). Among next therapies, csDMARD showed the trend towards shortest durability and JAKi – toward longest as monotherapies (median duration for csDMARD, TNFi, JAKi: 4.9, 5.9, 8.1 months respectively; p=0.2, comparing all) and combination therapies (median duration for csDMARD+csDMARD, TNFi+csDMARD, JAKi+csDMARD: 12.5, 14.9, 17.2 months respectively; p= 0.04).

CONCLUSIONS : The real-world evidence suggests that treatment durability may be better for JAKi than TNFi (both monotherapy and combination). The majority of csDMARD patients switched to another csDMARD, which showed short durability of treatment, suggesting that switching MOA may benefit patients.