SAT0066 BURDEN OF MALIGNANCY, VENOUS THROMBOEMBOLISM, ANEMIA, AND INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS WHO SWITCHED FROM A FIRST CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG TO ANOTHER DISEASE-MODIFYING ANTIRHEUMATIC DRUG REGIMEN
Authors: R. K. Dore, J. Antonova, L. Chang, H. Huang, H. Kim, M. C. Genovese
Journal: Annals of the Rheumatic Diseases (2020)

Background: EULAR and ACR guidelines recommend a variety of treatment options for rheumatoid arthritis (RA) patients who failed a first conventional synthetic disease-modifying antirheumatic drug (csDMARD). The recent launches of Janus kinase inhibitors (JAKi) have stimulated interest in comorbidities such as malignancy, venous thromboembolism (VTE: deep vein thrombosis [DVT] or pulmonary embolism [PE]), anemia, and infections in patients with RA. Understanding the epidemiology of these conditions can help optimize treatment decisions within the treat-to-target approach following the first csDMARD. Objectives: Estimate the real-world prevalence, incidence, and costs of these comorbidities among patients switching from a first csDMARD to another DMARD. Methods: From a large US health claims database, the study selected adults with RA (≥2 RA claims ≥30 days apart) who started a csDMARD regimen as first DMARD, then switched (index date [ID], 1/1/2012–3/31/2017) to another DMARD regimen (monotherapy or combination with csDMARD). All patients had continuous enrollment 1 year before and ≥1 year after the ID. The study estimated baseline prevalence (%) and on-treatment incidence (per 100 patient-years [P100PY]) of malignancy, VTE, anemia, and infections (any, serious, opportunistic, and herpes zoster). Generalized linear models with gamma distribution and log link function estimated the impact of baseline characteristics on mean annualized healthcare costs per-patient-per-year (PPPY) associated with incident conditions. The recycled prediction method calculated adjusted total costs differences of these conditions. Results: Among study patients (N = 7,816, median age 54 yrs, 74% female), the 38% on monotherapy index treatments had mean (standard deviation) treatment duration 9.2 (10.1) mo and the 52% on combination therapies had treatment duration 16.9 (13.0) mo. Baseline prevalence was 1.5% for VTE, 1.3% for malignancy, 15.6% for anemia, and 71.0% for infection (Figure 1). During next treatment, the incidence rates (P100PY) were: 0.7 for VTE, 2.1 for malignancy, 7.8 for anemia and 79.4 for infection (Figure 1). Modeling showed that total healthcare cost more than doubled for RA patients with vs without incident occurrence of malignancy (2.9), followed by PE (2.7) and DVT (2.1) ( P &lt; .0001) (Figure 2). Total PPPY adjusted healthcare costs were higher in patients with vs without incident conditions: DVT $60,430 vs $28,927, PE $77,942 vs $29,000, malignancy $81,779 vs $28,565, anemia $50,097 vs $26,959, and infection $32,431 vs $22,774, including serious infections $52,935 vs $26,723, opportunistic infections $39,239 vs $28,947, and herpes zoster $30,638 vs $29,515. Conclusion: In the real world, RA patients were affected by VTE, malignancy, anemia and infections prior to switching from first csDMARD to the next treatment. While on the next treatment, patients developed new cases of these comorbidities, most of which were associated with increased adjusted total healthcare costs. Clinicians should account for the burden of these comorbidities in selecting treatments for RA patients who failed their first csDMARD. Disclosure of Interests: Robin K Dore Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Jenya Antonova Employee of: Gilead Sciences. Inc., Lawrence Chang Consultant of: Gilead Sciences, Inc., Huan Huang Consultant of: Gilead Sciences, Inc., Hyunchung Kim Consultant of: Gilead Sciences, Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme