AB0399 EVOLUTION OF BIOLOGIC/SMALL MOLECULE SWITCHING PATTERNS IN RA BETWEEN 2016 AND 2018
Authors: Phil pouliot, Lynn Price
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> TNF therapy has been the standard of care for adult patients diagnosed with autoimmune conditions and are typically used as a first-line biologic/small molecule in the treatment of rheumatoid arthritis (RA). However, the adoption of systemic agents with alternate mechanisms of action (AMOA) such as JAK and interleukin inhibitors have increased in recent years across many indications. As such, the practice of sequential TNF prescribing following an initial TNF discontinuation is becoming less common, with switches to AMOAs, such as JAK and IL-6 inhibitors, becoming more popular. <h3>Objectives</h3> This research sought to track the evolution of biologic/small molecule switch patterns among US RA patients between 2016 and 2018 and to identify differentiating patient characteristics between the switch patterns. <h3>Methods</h3> An independent market analytics firm collaborated with US rheumatologists to conduct a retrospective chart review of RA patients who switched biologic/small molecule treatment 12 weeks prior to being surveyed. Physicians were able to submit up to 7 patient charts. Data were collected via a HIPAA-compliant online audit in January 2016 (n=198 rheumatologists/980 patient charts), in September 2017 (n=176 rheumatologists/1,002 patient charts), and September 2018 (211 rheumatologists/1,074 patient charts). Results were analyzed in SPSS. <h3>Results</h3> Analysis of patients recently switched from one biologic/small molecule to another revealed the decreasing popularity of cycling to another TNF after initial TNF discontinuation. TNF cycling accounted for 46% of all switches in 2016, 41% in 2017, and 40% in 2018. Conversely, switches from TNFs to JAK inhibitors accounted for 13% in 2016, 12% in 2017, and 15% in 2018. Switches to IL-6 inhibitors increased from 8% of all switches in 2016, to 9% in 2017, and 11% in 2018. The number of patients switched from a TNF to abatacept or rituximab remained stable over the study periods. Patients who were cycled to another TNF were diagnosed with RA for a shorter amount of time, had been on a biologic for less time, had a lower swollen joint count and CRP level, were more likely to be males, were least likely to require a prior-authorization for treatment, and more likely to have been switched due to tolerability issues. Consistent in all three years of data, patients switched to JAK inhibitors played a larger role in the switching decision, had a higher physician global assessment rating of global health, had a lower cardiovascular risk profile, were less likely to be prescribed concomitant methotrexate, and were more likely to participate in a manufacturer-sponsored co-pay assistance program. Patients switched to an IL-6 inhibitor were largely indistinguishable from those undergoing other types of switches; however, they were slightly more likely to have more severe RA, have a slightly lower average physician global health assessment rating, were more likely to be obese, and have an elevated cardiovascular risk. <h3>Conclusion</h3> While the practice of TNF cycling is still the most predominant switch pattern among RA patients migrating from a first-to-second line biologic/small molecule therapy, the practice has been declining over the last three years. Over time, rheumatologists are increasingly likely to introduce a JAK or IL-6 inhibitor in the second-line setting following discontinuation of a first-line TNF. <h3>Disclosure of Interests</h3> None declared