Fewer Than One-Third of New Patients With RA Receive Disease-Modifying Medications, Study Says

Fewer than one-third of patients newly diagnosed with rheumatoid arthritis (RA) used anti—tumor necrosis factor agents (anti-TNFs), other biologics, Janus kinase (JAK) inhibitors, or conventional disease-modifying antirheumatic drugs in 2014, according to a study published this month in the Journal of Managed Care and Specialty Pharmacy.

Researchers sought to identify characteristics associated with medication use in both existing patients and new patients with RA. They noted that while biologics and conventional disease-modifying antirheumatic drugs—which the authors referred to collectively as DMARDs—are recommended as the standard of care for RA, their use is low in some subgroups of patients.

The retrospective, observational study used 2014 administrative claims data from a large national health plan, including medical and pharmacy claims for individuals enrolled in a Medicare Advantage Prescription Drug (MAPD) plan or a commercial plan with medical and pharmacy benefits. Researchers wanted to identify the proportion of patients with at least 1 prescription claim for a DMARD or biologic among the patients identified with RA.

Researchers used the Healthcare Effectiveness Data and Information Set (HEDIS) to measure the proportion of patients receiving RA therapies. In 2005, the National Committee for Quality Assurance issued a HEDIS to determine the receipt of DMARDs among patients with RA by the disease-modifying antirheumatic drug therapy for rheumatoid arthritis (ART) measure. Managed care organizations offering Medicare plans are required to report ART performance, along with other HEDIS measures.

This study sought to identify modifiable and nonmodifiable characteristics associated with DMARD use per the ART measure among patients with RA.

This study included patients aged 18-89 years with continuous enrollment during 2014 with 2 or more claims for RA outpatient visits and/or discharges on different dates between January and November 2014. They also identified a subset of patients newly diagnosed with RA in 2014 based on the absence of any related claims in 2013.

Descriptive analyses and bivariate associations were used to compare demographic and clinical characteristics of patients with or without RA medication use in 2014. Health care resource utilization (HCRU) and costs were compared in 2014 for patients enrolled in MAPD plans during both 2014 and 2015. Regression models were used to evaluate patient and provider characteristics associated with RA therapy use in 2014 and the effect on HCRU and costs.

Among the 33,880 patients identified with RA in 2014, fewer patients were started on disease-modifying agents at diagnosis, which is recommended to prevent progression of disease and poorer outcomes. Most patients received a DMARD (75.2%), but just 29.4% of patients newly diagnosed with RA had been treated with DMARDs in 2014.

Using nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids was associated with lack of DMARD use, which may hint that painkillers are being used to mitigate RA symptoms instead of having a treatment plan in place. The use of NSAIDs (12.3%), opioids (19.5%), antidepressants (20.0%), muscle relaxants (12.5%), and anticonvulsants (15.5%), as associated with lower use of DMARDs (P <.0001).

Using DMARDs was associated with fewer hospitalizations, fewer emergency department visits, and lower total healthcare costs excluding DMARDs, compared with no DMARD use. Use of DMARDs was also associated with 14.5% fewer hospitalizations and 18.0% fewer emergency department visits (P <.0001). Although total costs increased by 15.0% with use of DMARDs, when the cost of DMARDs was excluded, total costs dropped by 13.7% (P <.0001).

On average, patients using RA-specific therapy were younger (aged 67 years vs 69 years) and healthier (Deyo-Charlson Comorbidity Index 2.4 vs 2.6) and included a greater proportion of women (75.9% vs 71.0%) than those with no DMARD use (P <.0001).

The factors that increased the odds of DMARD use include female gender (32.2%), higher claims-based index for RA severity score (47.0%), higher RxRisk-V score (26.7%), visit to a rheumatologist (34.3%), and use of glucocorticoids (17.7%) (P <.0001).

For MAPD plans, the average 2014 DMARD treatment rate for health maintenance organization plans was 76.7%, while for preferred provider organization plans, it was 80.5%, which fell below the 4-star rating threshold (82%) for that year. The national average star rating for DMARD treatment rate was 3.7 in 2014 and 3.5 in 2015.

Since 2014, there have been minimal changes to the national average of DMARD use, the authors said. Future research should investigate the reasons for lack of treatment, said the researchers.

Reference

Boytsov NN, Bhattacharya R, Saverno K, et al. Health care effect of disease-modifying antirheumatic drug use on patients with rheumatoid arthritis. J Manag Care Spec Pharm. 2019;25(8):879-887. doi: 10.18553/jmcp.2019.25.8.879.