Medicaid Patients Ditch Biologics for Rheumatoid Arthritis

Results of a recent study on Medicaid patients treated with biologic agents for rheumatoid arthritis, indicates that levels of poor adherence and premature discontinuation are strong.

The study, titled, “Adherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritis” was published in Value in Health. The study was co-authored by Pengxiang Li, Marissa A. Blum, Joan Von Feldt, Sean Hennessy, and Jalpa A. Doshi of University of Pennsylvania.

The study was designed to examine adherence, discontinuation, and switching of rheumatoid arthritis biologics over a one-year period in Medicaid patients. The RA biologics studied included etanercept, anakinra, and infliximab. The study participants were Medicaid patients with RA in California, Florida and New York.

Biological treatments represent promising advances for individuals with rheumatoid arthritis (RA), and have been associated with significant improvement in outcomes including reduction in pain, joint swelling, serologic inflammatory indices, and rates of radiologic damage.

Few studies have examined adherence to and/or persistence on biologics in RA patients in the US, especially among Medicaid enrollees. Since the Medicaid population comprises a large part of the public payer health system as well as tends to be underrepresented in clinical trials, it is important to examine adherence to and discontinuation of RA biologics in such patients.

“This study provides valuable insights on the patterns of use of newly initiated RA biologics in routine clinical practice in three large state Medicaid programs whose combined enrollment represents approximately one-third of the total Medicaid enrollment in the U.S,” Dr. Li said, in a press release.

“Our findings of poor adherence to and premature discontinuation without concurrent switching of RA biologics among patients newly initiating these highly effective but expensive agents should raise concern for clinicians as well as payers,” Dr. Doshi said.

The implication of the study findings will be discussed in Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research.

Value in Health focuses on publishing papers, concepts, and ideas to advance the field of pharmacoeconomics and outcomes research. It also seeks to help health care leaders to make evidence-based decisions. The journal is published bi-monthly and has a regular readership of over 5,000 clinicians, decision-makers, and researchers worldwide.

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What do you suspect are the causes of low adherence in this population?