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Research ArticleRheumatoid Arthritis

Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset

Peter Youssef, Bruno Marcal, Peter Button, Matt Truman, Paul Bird, Hedley Griffiths, Lynden Roberts, Kathleen Tymms and Geoff Littlejohn
The Journal of Rheumatology August 2020, 47 (8) 1174-1181; DOI: https://doi.org/10.3899/jrheum.190535
Peter Youssef
From the Royal Prince Alfred Hospital, Camperdown; University of Sydney, Sydney; Roche Products Pty Ltd., Sydney; OzBiostat Pty Ltd., Sydney; University of New South Wales, Sydney; Barwon Rheumatology Service, Geelong; Monash Rheumatology, Clayton; Canberra Rheumatology, Canberra; Monash University, Clayton, Australia.
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  • ORCID record for Peter Youssef
  • For correspondence: pyoussef@med.usyd.edu.au
Bruno Marcal
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Peter Button
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Matt Truman
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Paul Bird
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Hedley Griffiths
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Lynden Roberts
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Kathleen Tymms
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Geoff Littlejohn
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Abstract

Objective. To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi).

Methods. This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation.

Results. Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was “lack of efficacy” (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9–12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27–74).

Conclusion. A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.

Key Indexing Terms:
  • DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
  • MEDICATION PERSISTENCE
  • RHEUMATOID ARTHRITIS
  • BIOLOGIC THERAPY

Footnotes

  • This study was supported by Roche Products Pty Ltd. (Australia). B.M. is an employee of Roche Products Pty Ltd. and reports stock ownership at Roche. P.B. was an employee of Roche Products Pty Ltd. until December 2017 and then worked as a consultant statistician during the conduct of the study. M.T. was an employee of Roche Products Pty Ltd. until December 2017 and then worked as a consultant statistician during the conduct of the study; and he reports stock ownership at Roche.

  • Accepted for publication November 20, 2019.
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1 Aug 2020
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Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset
Peter Youssef, Bruno Marcal, Peter Button, Matt Truman, Paul Bird, Hedley Griffiths, Lynden Roberts, Kathleen Tymms, Geoff Littlejohn
The Journal of Rheumatology Aug 2020, 47 (8) 1174-1181; DOI: 10.3899/jrheum.190535

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Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset
Peter Youssef, Bruno Marcal, Peter Button, Matt Truman, Paul Bird, Hedley Griffiths, Lynden Roberts, Kathleen Tymms, Geoff Littlejohn
The Journal of Rheumatology Aug 2020, 47 (8) 1174-1181; DOI: 10.3899/jrheum.190535
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Keywords

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
MEDICATION PERSISTENCE
RHEUMATOID ARTHRITIS
BIOLOGIC THERAPY

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Keywords

  • disease-modifying antirheumatic drugs
  • MEDICATION PERSISTENCE
  • rheumatoid arthritis
  • BIOLOGIC THERAPY

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