Disparities in Targeted Immune Modulating (TIM) Treatment for Elderly Compared to Younger Patients with Psoriatic Arthritis (PSA); Observations of US Clinical Practice from Trio Health and the American Rheumatology Network (ARN).
Singh JA1, Frick A2, Broestl JE3, Helfgott SM4, Huston K5, Soloman N6, Tesser J6, Edgerton C7
1University of Alabama at Birmingham, Birmingham, AL, USA, 2Trio Health, La mirada, CA, USA, 3Trio Health, Louisville, CO, USA, 4Brigham and Women's Hospital, Boston, MA, USA, 5The Center for Rheumatic Disease & Allergy-Immunology, Kansas City, MO, USA, 6Arizona Arthritis, Phoenix, AZ, USA, 7Articularis Healthcare, Summerville, SC, USA
OBJECTIVES Targeted immunomodulating (TIM) therapies (JAK inhibitors and biologics) are as effective in the elderly as in younger patients with PsA. However, balancing the greater comorbidity burden associated with aging may influence prescribing patterns as clinicians seek to avoid serious adverse events in the ≥65-year-old population. Here, we examine associations between age and TIM treatment patterns in a large US community rheumatology practice registry. METHODS This study analyzed patients diagnosed with PsA and who initiated care with conventional synthetic DMARD (csDMARD) monotherapy between Jan 2014 to Nov 2019 with follow-up of ≥6 months. Disease Activity Scores (DAS) were calculated using CDAI or RAPID-3. Differences in time to initiation of TIM containing regimens were analyzed with KM curves and associated Log-Rank Test for difference in hazard. RESULTS 524 patients met all inclusion criteria. Age groups <65y (387, 74%) and ≥65y (137, 26%) were not significantly different by gender, race, ethnicity, hypertension, or baseline DAS. Diabetes and osteoporosis were significantly higher in the ≥65y group (p<0.01). 495 (94%) of patients initiated TIM therapy within 2 years of first csDMARD regimen. No differences in time to initiation of TIM were observed by baseline DAS (p = 0.11) or payer type (p = 0.29). Via KM Curves, patients in the older cohort remained on csDMARD regimens significantly longer than younger patients, 6.8 vs. 4.0 months [p=0.02] . Upon treatment with TIM therapies, patients ≥65y were more likely to receive infused therapy +/- csDMARDS (22% ≥65y vs 12% <65y, p<0.01). CONCLUSIONS Overall, comorbidity burden is an important consideration in timing and choice of targeted therapies. These data suggest that differences in treatment exist between age groups even when comorbidity differences are minimized and raise the possibility to age bias may influence care for ≥65y population.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Health Service Delivery & Process of Care
Hospital and Clinical Practices, Prescribing Behavior, Quality of Care Measurement, Treatment Patterns and Guidelines
Geriatrics, Systemic Disorders/Conditions