Persistence Among Biologic/JAKi-Naive Medicare Beneficiaries with RA Initiating Synthetic DMARDs

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) persistence is an indirect measure of real-world treatment tolerability and effectiveness.
• Clinical trials suggest seropositive RA patients may benefit from abatacept.
• This study examined non-persistence risks for abatacept, TNFi, and JAKi as first-line b/tsDMARDs.

Purpose of the Study:

• To compare the 12-month persistence rates of abatacept, TNFi, and JAKi in anti-CCP+ and RF+ RA patients initiating first-line b/tsDMARD therapy.
• To evaluate the risk of non-persistence associated with each treatment class.

Main Methods:

• Utilized Medicare Fee-For-Service claims linked with Prognos laboratory data (2012-2019).
• Identified newly-initiating anti-CCP+ and RF+ RA patients starting abatacept, TNFi, or JAKi as first-line b/tsDMARDs.
• Defined persistence as no treatment gap ≥60 days, >90 days off-treatment, or therapy switch at 12 months; employed Cox regression analysis.

Main Results:

• Of 3105 patients, 487 (16%) received abatacept, 2330 (75%) TNFi, and 288 (9%) JAKi.
• Twelve-month persistence rates were 48% for abatacept, 33% for TNFi, and 39% for JAKi.
• Abatacept initiators had higher persistence than TNFi (HR 1.45) and JAKi initiators (HR 1.43).

Conclusions:

• Real-world data indicate abatacept may improve persistence in anti-CCP+ and RF+ RA patients compared to common first-line alternatives.
• Abatacept demonstrates potential for enhanced treatment adherence in this specific RA population.
• Findings support considering abatacept for improved patient persistence in initial RA therapy.