Background: Adherence to biologic disease-modifying anti-rheumatic drugs (bDMARDs) is essential to control rheumatoid arthritis (RA). Compared to traditional approaches, longitudinal adherence trajectories can provide important information to improve treatments efficiency. Objectives: One of the aims of the PATHFINDER study, is to identify longitudinal adherence trajectories to bDMARDs in Tuscan RA patients. Methods: A retrospective drug utilization study was carried out on data collected in the Tuscan administrative databases. We included patients matching the following criteria: the first bDMARD dispensation between 2010 and 2015 (index date); RA diagnosis 5 years before or 1 year after the index date, or RA visit within one year before and after. Patients were followed for 3 years or until death. Adherence was estimated quarterly through the Medication Possession Ratio. We clustered patients into groups, we identified trajectories, and we described baseline characteristics. A further analysis, excluding patients with a low adherence behaviour and subsequently re-clustering, was performed. Results: We selected 3,449 patients. Females were 2,316 (67.1%). The mean age was 53.6 (standard deviation, SD 16.7). The index bDMARDs were etanercept (1,328, 38.5%), adalimumab (1,104, 32%), infliximab (299, 8.7%), golimumab (253, 7.3%), abatacept (177, 5.1%), certolizumab (156, 4.5%), and tocilizumab (132, 3.8%). Two adherence trajectories were identified: high (92.1% of patients), and low (7.9%). Younger patients were observed in the high adherence trajectory (53.3, SD 16.7, p=0.003). At baseline, conventional synthetic DMARDs (74.0%) were most frequent in the high trajectory (93%), while a significant occurrence of other gastrointestinal disorders was observed in the low adherence trajectory. When we excluded low adherent patients and re-clustered data, 3,142 patients were grouped in three trajectories: high (2,098 patients), medium-low (743), and low (301). We observed a significant distribution of infliximab in the high adherence trajectory (203, 9.7%, p=0.02) and other cardiovascular and lung disorders in the low adherence trajectory. The medium-low trajectory was characterized by wide adherence variability over time. Conclusions: Our findings showed that the majority of RA patients had a high adherence behavior over time to bDMARDs. Infliximab is the index drug more frequently reported in the high adherence trajectory, while comorbidities characterized the low adherence trajectory.

Longitudinal adherence trajectories to biologic disease modifying anti-rheumatic drugs in Tuscany, Italy

Convertino, I;Tuccori, M;Cazzato, M;Valdiserra, G;Ferraro, S;Tillati, S;Fornili, M;Turchetti, G;Trieste, L;Lorenzoni, V;Blandizzi, C;Mosca, M;Lucenteforte, E
2021-01-01

Abstract

Background: Adherence to biologic disease-modifying anti-rheumatic drugs (bDMARDs) is essential to control rheumatoid arthritis (RA). Compared to traditional approaches, longitudinal adherence trajectories can provide important information to improve treatments efficiency. Objectives: One of the aims of the PATHFINDER study, is to identify longitudinal adherence trajectories to bDMARDs in Tuscan RA patients. Methods: A retrospective drug utilization study was carried out on data collected in the Tuscan administrative databases. We included patients matching the following criteria: the first bDMARD dispensation between 2010 and 2015 (index date); RA diagnosis 5 years before or 1 year after the index date, or RA visit within one year before and after. Patients were followed for 3 years or until death. Adherence was estimated quarterly through the Medication Possession Ratio. We clustered patients into groups, we identified trajectories, and we described baseline characteristics. A further analysis, excluding patients with a low adherence behaviour and subsequently re-clustering, was performed. Results: We selected 3,449 patients. Females were 2,316 (67.1%). The mean age was 53.6 (standard deviation, SD 16.7). The index bDMARDs were etanercept (1,328, 38.5%), adalimumab (1,104, 32%), infliximab (299, 8.7%), golimumab (253, 7.3%), abatacept (177, 5.1%), certolizumab (156, 4.5%), and tocilizumab (132, 3.8%). Two adherence trajectories were identified: high (92.1% of patients), and low (7.9%). Younger patients were observed in the high adherence trajectory (53.3, SD 16.7, p=0.003). At baseline, conventional synthetic DMARDs (74.0%) were most frequent in the high trajectory (93%), while a significant occurrence of other gastrointestinal disorders was observed in the low adherence trajectory. When we excluded low adherent patients and re-clustered data, 3,142 patients were grouped in three trajectories: high (2,098 patients), medium-low (743), and low (301). We observed a significant distribution of infliximab in the high adherence trajectory (203, 9.7%, p=0.02) and other cardiovascular and lung disorders in the low adherence trajectory. The medium-low trajectory was characterized by wide adherence variability over time. Conclusions: Our findings showed that the majority of RA patients had a high adherence behavior over time to bDMARDs. Infliximab is the index drug more frequently reported in the high adherence trajectory, while comorbidities characterized the low adherence trajectory.
2021
https://onlinelibrary.wiley.com/toc/10991557/2021/30/S1
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1106748
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