FRI0181 Changing Use of Methotrexate (MTX) and Biologics in The Treatment of Rheumatoid Arthritis (RA) in The United States (US): Results of A Comprehensive Pharmaceutical Claims Analysis: Table 1
Authors: J.R. O'Dell, S. Cohen, C. Thorne, T.R. Mikuls
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> European and US guidelines recommend MTX as part of initial treatment for patients with RA.<sup>1,2</sup> Biologic agents are recommended for patients with poor prognostic indicators and those who fail to achieve treatment goals after 3–6 months of conventional therapy.<sup>1,2</sup> Currently, it is not clear how closely these recommendations are being followed in the US. <h3>Objectives</h3> To assess patterns of treatment for patients who initiated DMARD treatment in the US in either 2009 or 2012 and were followed for at least 2 years. <h3>Methods</h3> The analysis used Symphony Health Solutions9 anonymized patient-level claims data which captures ∼274 million US patients. Analysis included RA patients identified by ICD-9 codes 714.0 and 714.30 who initiated treatment with either oral MTX or a biologic therapy in 2009 or in 2012 and were followed for 2 years. Information obtained included: demographic characteristics, initial treatments, switches from oral to subcutaneous (SC) MTX and/or biologics (with or without concomitant MTX), timing of treatment changes, and oral MTX or SC MTX dosing at the times of switches/additions or end of follow-up. <h3>Results</h3> The study included 48,910 patients who initiated treatment in 2009 and 107,636 who started treatment in 2012 (Table). For the RA patients who started treatment in 2009, 27.1% initiated therapy with a biologic and 72.9% started on oral MTX. The respective values for patients initiating therapy in 2012 were 35.6% and 64.4%. Over the first 2 years of follow-up, 35.2% of patients who started MTX in 2009 and 21.6% of those started on MTX in 2012 switched to a biologic or had one added to MTX. A small percentage of patients in each cohort switched from oral to SC MTX. The median duration of oral MTX treatment prior to switching to or adding a biologic was 60 days for patients who initiated treatment in 2009 and 177 days for those who initiated MTX in 2012. <h3>Conclusions</h3> In the US, a large percentage of RA patients receive a biologic without a prior trial of MTX and this approach to treatment increased from 2009 to 2012. While there is a trend toward underuse of MTX as initial treatment from 2009 to 2012, a higher percentage of patients who started MTX in 2012 remained on this treatment for at least 2 years vs those started in 2009. This suggests many clinicians may not be following best practice with regard to the use of SC MTX. <h3>References</h3> Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73:492–509. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68:1–26. <h3>Acknowledgement</h3> Study sponsored by Medac Pharma, Inc. <h3>Disclosure of Interest</h3> J. O9Dell: None declared, S. Cohen Grant/research support from: Abbvie, Amgen, Astellas, Medac, Pfizer, UCB, C. Thorne Grant/research support from: Abbive, Amgen, Celgene, CaREBiodam, Lilly, Novartis, Pfizer, Sanofi, UCB, Consultant for: Abbvie, Centocor, Genzyme, Hospira, Medexus, Pfizer, Paid instructor for: Abbvie, Centocor, Genzyme, Hospira, Medexus/Medac, Pfizer, T. Mikuls Grant/research support from: Roche/Genentech, Consultant for: Pfizer