SAT0076 Effectiveness of RA BIOLOGICS in the Two Years following Initiation Using A Validated Claims-Based Algorithm

Background Biologic disease modifying antirheumatic drugs (DMARD) are a mainstay of Rheumatoid Arthritis (RA) treatment. A validated claims-based RA biologic effectiveness algorithm was developed 1 , allowing administrative claims data to be used for comparative effectiveness research. Objectives To estimate time while effectively treated with biologics for RA over 2-years following biologic initiation using a claims based algorithm. Methods Adults (18-63) newly initiating a biologic for RA (etanercept, abatacept, adalimumab, certolizumab, golimumab, or infliximab) from Jan 2009 to July 2011 were identified in the MarketScan ® U.S. Commercial Database. The patient9s first biologic claim (index claim) defined their treatment cohort. Patients were required to be continuously enrolled 6-months pre- and 24-months after their index claim, have a pre-index RA diagnosis and no pre-index biologic use or other conditions for which the study biologics are FDA-approved. Effectiveness was estimated using a claims-based algorithm 1 . Medications were classified as effective until subjects failed any of the algorithm9s 6 criteria: biologic dose escalation, switching biologics, adding a new non-biologic DMARD, receiving >1 intra-articular injection per year, adding a glucocorticoid, increasing glucocorticoid dose, or low treatment compliance ( Results 8,193 patients met the study selection criteria (mean age, 49, 78% female). More patients initiated etanercept (43%) or adalimumab (32%) than infliximab (12%), abatacept (7%), golimumab (4%) or certolizumab (2%). On average, patients had 526 days while effectively treated over the 2-year follow-up. The time while the medications were effective according to the algorithm was significantly higher for etanercept (538 days) than abatacept (482 days) or infliximab (480 days). Time while effectively treated was not statistically significantly different among subcutaneous therapies, etanercept (538 days), adalimumab (535 days), golimumab (537 days), or certolizumab (524 days). Sensitivity analyses varying the time not effective assigned to each failure event changed the overall effectiveness time but not treatment rankings. The majority of patients (85%) had at least 1 failure event (mean 3.2). Low compliance was the most common failure type for subcutaneous (76%) and infused biologics (80%), followed by switching biologics (26%), adding a non-biologic DMARD (17%), increasing glucocorticoid dose (17%) and increasing biologic dose (14%). Etanercept had the lowest failure rate (82%) and number of failures per patient (3.0) followed by adalimumab (84%*; 3.1*), certolizumab (85%; 3.3*), golimumab (86%*; 3.0), abatacept (93%*; 4.4*), and infliximab (95%*; 4.2*) (*: p Conclusions Patients initiating biologic treatment for RA had, on average, 526 days while effectively treated according to the algorithm during the 2-years following initiation. This varied from 480 (infliximab) to 538 days (etanercept). References Curtis et al. Arthritis Res Ther, 2011, 13(5), R155 Acknowledgements Research funded by Immunex Corporation, a wholly owned subsidiary of Amgen Inc. Disclosure of Interest M. Bonafede: None declared, B. Johnson: None declared, N. Princic: None declared, N. Shah Shareholder of: Amgen, Employee of: Amgen, D. Harrison Shareholder of: Amgen, Employee of: Amgen DOI 10.1136/annrheumdis-2014-eular.2267