Rheumatoid arthritis (RA) has a considerable economic burden, and costly biologic drugs, including anti–tumor necrosis factor (TNF) agents, are often prescribed in cases in which patients fail to respond adequately to methotrexate.
Rheumatoid arthritis (RA) has a considerable economic burden, and costly biologic drugs, including anti—tumor necrosis factor (TNF) agents, are often prescribed in cases in which patients fail to respond adequately to methotrexate.
However, a high rate of inadequate response to anti-TNFs in patients initiating biologic treatment can result in patients switching—or “cycling”—to alternative anti-TNF products. This cycling can be associated with reduced efficacy and the increased likelihood of switching to an a non—anti-TNF biologic, and may not represent a cost-effective strategy.
A recent study, funded by Pfizer, sought to assess whether tofacitinib, an oral Janus kinase inhibitor administered twice daily at a dose of 5 mg, could represent a cost-effective second-line treatment after methotrexate, third-line treatment after methotrexate and 1 anti-TNF drug, or fourth-line treatment after methotrexate and 2 anti-TNF drugs.
In total, 1321 patients were included in the analysis. The researchers used a decision-tree economic model to evaluate costs over a 2-year time horizon, with treatment response modeled on the American College of Rheumatology’s 20%, 50%, and 70% response criteria (ACR20/50/70). Response rates at 6-month intervals were derived from US prescribing information for monotherapy and combination therapy. Patients with an inadequate response to methotrexate entered the model and initiated treatment with tofacitinib, adalimumab, or etanercept. Drug costs were derived from January 2017 wholesale acquisition costs and approved dosing schedules. Other costs were derived from 2016 data.
The researchers found that:
The researchers concluded that total 2-year costs and PMPM costs were lowest when tofacitinib was used as second-line treatment after methotrexate. “A treatment strategy with introduction of tofacitinib early in the sequence, as either second- or third-line therapy after [methotrexate], may be a lower-cost treatment option when compared with fourth-line introduction of tofacitinib,” write the authors.
Reference
Claxton L, Taylor M, Soonasra A, Bourret JA, Gerber RA. An economic evaluation of tofacitinib treatment in rheumatoid arthritis after methotrexate or after 1 or 2 TNF inhibitors from a US payer perspective. J Manag Care Spec Pharm. 2018;13:1-8. doi: 10.18553/jmcp.2018.17220.
How AI Can Help Address Cost-Related Nonadherence to Biologic, Biosimilar Treatment
March 9th 2025Despite saving billions, biosimilars still account for only a small share of the biologics market—what's standing in the way of broader adoption and how can artificial intelligence (AI) help change that?
FDA Approves Another Pair of Denosumab Biosimilars, Conexxence and Bomyntra
March 27th 2025The FDA approved another set of denosumab biosimilars, Conexxence/Bomyntra (denosumab-bnht), expanding treatment options for osteoporosis, bone metastases, and other bone-related conditions, amidst a flurry of similar approvals and legal settlements.
Will the FTC Be More PBM-Friendly Under a Second Trump Administration?
February 23rd 2025On this episode of Not So Different, we explore the Federal Trade Commission’s (FTC) second interim report on pharmacy benefit managers (PBMs) with Joe Wisniewski from Turquoise Health, discussing key issues like preferential reimbursement, drug pricing transparency, biosimilars, shifting regulations, and how a second Trump administration could reshape PBM practices.
Biosimilar Natalizumab-sztn Shows Comparable Efficacy and Safety to Tysabri in RRMS
March 25th 2025Biosimilar natalizumab demonstrated comparable efficacy, safety, and immunogenicity to reference drug Tysabri in patients with relapsing-remitting multiple sclerosis (RRMS), supporting its potential as a cost-effective treatment option.