gms | German Medical Science

Introduction: German treatment guidelines for RA recommend treatment with DMARDs once RA has been diagnosed. In most cases treatment with conventional synthetic (cs)DMARDs is initiated and treatment change is requested in case of inadequate response (IR). In the presence of unfavorable prognostic factors, escalation from csDMARD to biologic (b)DMARD, or janus kinase inhibitors (JAKi) is recommended. This study aimed to investigate baseline characteristics and treatment patterns including treatment persistence in csDMARD-IR and bDMARD-IR patients.

Methods: For this retrospective claims database analysis we utilized anonymized data of ~4 million patients in Germany. RA patients (≥2 RA diagnoses within 12 months, ≥1 by a rheumatologist) initiating index treatment with a csDMARD, bDMARD or JAKi between 2017 and 2018 were selected. csDMARD-IR and bDMARD-IR patients were defined as having at least one previous csDMARD or bDMARD, respectively, in the pre-index period of 24 months. Persistence was defined as no treatment gap of more than 60 days between days of supply.

Results: A total of 3,858 patients initiating treatment were identified, of which 990 were classified as csDMARD-IR (median age 60 years, 71.9% female) and 375 as bDMARD-IR (median age 60 years, 74.9% female). Baseline comorbidity burden measured by the Updated Charlson Comorbidity Index was comparable between csDMARD-IR and bDMARD-IR group.

Majority of patients among csDMARD-IR initiated treatment with tumor necrosis factor inhibitors TNFi (n=433, 43.7%) followed by JAKi (n=235, 23.7%). bDMARD-IR initiated treatment most frequently with JAKi (n=285, 76.0%). Sample sizes were low for other available DMARDs. Median time on treatment with respective DMARD therapy was 215 days in both groups. For csDMARD-IR patients, persistence in the 12-month follow-up for JAKi was 47.2% (n=111) followed by anti-IL-6 (45.7%, n=21) and TNFi (43.4%, n=188). For bDMARD-IR patients, persistence with JAKi was 40.4% (n=115). Low absolute numbers for anti-IL-6 (n=8), anti-CD80/86 (n=5), and TNFi (n=15) have limited valid estimates of persistence in bDMARD-IR.

Conclusion: This study is the first to provide a detailed analysis of treatment patterns and baseline characteristics in RA in a real world setting in Germany. JAKi show the highest rate of drug persistence in csDMARD-IR and are the preferred drugs for bDMARD-IR.

Disclosures: This study was sponsored by Gilead Sciences. Professor Fiehn has received consulting fees from Abbvie, Ablynx, BMS, Celgene, Gilead, Jansen, Lilly, MSD, Medac, Novartis, Pfizer, Roche, Sanofi, and UCB. Jennifer Haas is an employee of Xcenda GmbH, a company that received funding from Gilead Sciences to conduct this study. Hans-Dieter Orzechowski, Margot Gurrath and Vidya Prasad are former employees of Gilead Sciences and may have stock.