Trial-and-Error Treatment Leads To Delayed Disease Control of Moderate-to-Severe Rheumatoid Arthritis
Author(s)
Huston K1, Helfgott SM2, Singh JA1, Frick A3, Milligan S4, Persons D3, Soloman N5
1The Center for Rheumatic Disease & Allergy-Immunology, Kansas City, MO, USA, 2Harvard Medical School, Boston, MA, USA, 3Trio Health Analytics, Louisville, CO, USA, 4Trio Health Analytics, Belfast, ME, USA, 5Arizona Arthritis, Phoenix, AZ, USA
Presentation Documents
OBJECTIVES: For patients who have failed or are intolerant to conventional synthetic DMARDs, treatment choice is arguably based on population experience and not individualized to the patient. To assess the potential impact of precision medicine on outcomes, we examined time and treatments prior to low disease activity (LDA) for patients with moderate-severe RA after initiating biologic (b) or targeted synthetic (ts) DMARDs.
METHODS: Data: PIONEER-Rheumatology, an EMR and open text-extracted database specific to care given by the American Rheumatology Network. Study populations: Patients (18+) with RA who first initiated b/tsDMARDs 2014-2021 (index), ≥90 days history, ≥365 days follow up, Clinical Disease Activity Index (CDAI) >10 at index and ≤10 (LDA) post-index. Analyses: Time to LDA from initiation of (1) first b/tsDMARD and (2) last b/tsDMARD preceding LDA. Statistics: Mann-Whitney U test, Pearson’s chi-square with proportions comparisons by Z-test, Bonferroni adjustment.
RESULTS: Study population (n=1713). Prior to LDA, 81% received 1, 14% received 2, and 5% received ≥3 b/tsDMARDs. For patients achieving LDA with 1 b/tsDMARD (81%), median (IQR) months from index to LDA was 4.75 (2.30-10.78). For patients achieving LDA after 2 b/tsDMARDs (14%), median (IQR) months to LDA from index was 14.53 (7.79-21.76) and from initiation of the last b/tsDMARD was 4.93 (2.07-9.90). For those achieving LDA after ≥3 b/tsDMARDs (5%), median (IQR) months to LDA from index was 23.16 (15.12-31.91) and from last b/tsDMARD was 5.59 (2.38-11.81). Comparisons between 1, 2, and ≥3 b/tsDMARDs groups revealed statistically significant differences in time to LDA from first b/tsDMARD (all p<0.001) and the lack of significant differences in time to LDA from last b/tsDMARD (all p>0.99).
CONCLUSIONS: These results suggest that selection of an ineffective therapy initially via trial-and-error prescribing may delay disease control by 3-fold for some patients. Using available personalized medicine tests which predict response to therapy may help patients achieve LDA sooner.
Conference/Value in Health Info
Value in Health, Volume 27, Issue 6, S1 (June 2024)
Code
CO97
Topic
Clinical Outcomes, Economic Evaluation, Organizational Practices, Patient-Centered Research
Topic Subcategory
Clinical Outcomes Assessment, Industry, Patient-reported Outcomes & Quality of Life Outcomes
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Personalized & Precision Medicine