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Long-term Comparative Adherence and Switch Rates in Patients Receiving Advanced Therapies for Rheumatoid Arthritis
Christina Charles-Schoeman1, Kurt Oelke2, Patrick M Zueger3
1Division of Rheumatology, Department of Medicine, Harbor-University of California Los Angeles Medical Centre, Los Angeles, CA, USA. ccharles@mednet.ucla.edu.
Introduction:
Patients with rheumatoid arthritis (RA) often fail to achieve treatment targets with first-line treatment because of poor efficacy or tolerability. However, comparative long-term adherence and switching data among patients initiating a second-line therapy after a first-line tumor necrosis factor inhibitor (TNFi) remain limited.
Methods:
Retrospective data were from the Merative MarketScan® claims database, August 2018-October 2024. Eligible patients were aged ≥ 18 years; diagnosed with RA; initiated upadacitinib (UPA), tofacitinib (TOF), adalimumab (ADA), etanercept (ETA), abatacept (ABA), or tocilizumab (TOC); and had discontinued a first-line TNFi within 12 months prior to index. Treatment adherence and switching outcomes were reported at 1- and 3-year follow-up.
Results:
Overall, 3782 and 1182 patients were included for the 1- and 3-year analyses, respectively. The proportion of patients with adherence ≥ 80% was highest with UPA at 1-year (49.5%) and 3-year follow-up (35.7%) versus other treatments. Compared with UPA through 3 years, odds of being adherent were significantly lower for TOF (adjusted odds ratio [95% confidence interval]: 0.45 [0.29-0.71]), ADA (0.50 [0.33-0.75]), ETA (0.37 [0.24-0.58]), ABA (0.43 [0.26-0.73]), and TOC (0.46 [0.22-0.99]; p < 0.05). Switch rates were lowest for UPA versus other treatments at 1 year (28.6%) and remained lowest through 3 years (47.6%), while rates for all other treatments increased to approximately 60%. Through 3 years, patients were also significantly (p < 0.05) more likely to switch treatment when receiving TOF (adjusted hazard ratios [95% confidence interval]: 1.40 [1.07-1.84]), ADA (1.44 [1.12-1.86]), ETA (1.57 [1.21-2.03]), ABA (1.56 [1.16-2.10]), and TOC (1.54 [1.03-2.32]) compared with UPA. Median 3-year time to switch was not reached for UPA and was 528-660 days for all other treatments.
Conclusion:
Among patients with RA who discontinued a first-line TNFi, second-line UPA was associated with significantly greater long-term adherence and lower switching rates than other advanced therapies.
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