OBJECTIVES: The objective of this study is to evaluate recent real-world treatment patterns and time to biologic disease modifying anti-rheumatic drug (bDMARD) discontinuation using retrospective claims data in rheumatoid arthritis (RA) patients in the United States.

METHODS: Patients receiving a bDMARD for RA between 10/2015 and 09/2016 were identified from the Symphony Health claims database. A minimum age of 18 years and 6 months pre- and post-initiation of medical and pharmacy claims activity was required. Market share, patient characteristics, and time to treatment discontinuation (TTD) were examined. TTD was defined as days from biologic start to initiation of the next biologic, plus 1 day if switched; or days from biologic start to last biologic administration date plus 90 days. TTD was described using Kaplan-Meir curves.

RESULTS: Of 83,050 patients treated with bDMARDs, 64,994 (78.3%) were female, mean (SD) age was 55.2 (12.9), mean (SD) number of biologics per patient was 1.2 (0.4). Patients received 105,485 total bDMARD lines of therapy: 31,084 (29.5%) adalimumab, TTD=558 days; 28,352 (26.9%) etanercept, TTD=644; 10,362 (9.8%) abatacept, TTD=575; 10,116 (9.6%) tofacitinib, TTD=500; 7,974 (7.6%) infliximab, TTD=679; 5,009 (4.7%) tocilizumab, TTD=495; 4,301 (4.1%) golimumab, TTD=535; 4,060 (3.8%) certolizumab, TTD=535; 3,877 (3.7%) rituximab, TTD=495; and 350 (0.3%) anakinra, TTD=535. Mean TTD by line of therapy was: 622 days in first line, 434 in second line, and 365 in third line or higher.

CONCLUSIONS: bDMARDs provide durable responses in RA patients. Approximately two-thirds of RA patients were treated with adalimumab, etanercept, or abatacept. The most frequently used biologics do not necessarily rank highest in terms of mean TTD. TTD significantly differs by agent and line of therapy, and declines with each subsequent biologic line. Evaluation of patient characteristics contributing to longer TTD, is warranted. Comparative effectiveness research is needed to determine optimum treatments and sequencing.