Rheumatoid Arthritis Patients Adhere Better to Abatacept than TNF, JAK Inhibitors

Sang Hee Park, MPH

Abatacept (Orencia) is associated with greater 1-year treatment persistence and reduced risk of discontinuation among seropositive patients with rheumatoid arthritis than other patients on tumor necrosis factor (TNF) or Janus kinase (JAK) inhibitor therapy, according to new findings.

In new data presented at the American College of Rheumatology (ACR) 2021 Convergence this week, a team of Bristol Myers Squibb (BMS) investigators reported findings suggesting the modified antibody therapy is associated with greater adherence than competitor therapies for rheumatoid arthritis, as was observed in a cohort of Medicare beneficiaries.

Led by Sang Hee Park, MPH, Health Economics and Outcomes Researcher with BMS, investigators sought to describe patient treatment persistence to abatacept compared to 2 treatment groups—patients receiving TNF or JAK inhibitors—among patients with seropositive rheumatoid arthritis on Medicare. They noted that recent clinical and retrospective studies have suggested that seropositive rheumatoid arthritis treated with abatacept is associated improved clinical outcomes than those with biologic therapy or DMARDs.

“This biomarker-defined patient group may also demonstrate increased treatment durability,” investigators noted.

Park and colleagues conducted a retrospective cohort analysis of 100% Medicare Fee-for-Service Parts A/B/D claims linked to data from the Prognos laboratory from 2012 through 2019. Eligible patients had ≥2 claims in any setting on separate days, ≥7 days apart, with diagnosed seropositive rheumatoid arthritis.

Patients were exclusively treated with either abatacept, TNF inhibitor, or JAK inhibitor; they were required to have ≥1 year of continuous pre- and post-index enrollment. Index dates were defined as time of arthritis treatment initiation.

Investigators reported baseline demographic and clinical characteristics while evaluating for treatment persistence during follow-up. They calculated treatment persistence for each patient from the index date until earliest occurrence of 15-plus-day treatment gap. Kaplan Meier curves and Cox proportional hazard model were used to estimated risk of time to treatment discontinuation over 1 year, with adjustment for baseline patient characteristics.

Park and colleagues assessed 3468 seropositive rheumatoid arthritis: 528 (15.2%) received abatacept; 2654 (76.5%) received TNF inhibitor; 295 (8.5%) received JAK inhibitors. Mean patient age was 66.4 years old, with more than three-fourths being female (78.3%) and White (73.9%). About 9 in 10 patients were naïve to biology therapy prior to index.

Treatment persistence to index medication for 1 year was most frequent among patients receiving abatacept (21.4%), followed by TNF inhibitors (18.2%), then JAK inhibitors (12.5%). Patients on abatacept spent a median 269 days on abatacept, 206 days on a TNF inhibitor, and 218 days on a JAK inhibitor. Time to treatment discontinuation was nearly doubled among abatacept recipients (152 days) than patients on TNF inhibitors (97) or JAK inhibitors (89).

After adjusting for baseline patient demographics and clinical characteristics, patients on abatacept had approximately 30% longer duration until discontinuation versus TNF inhibitors (HR, 1.3; 95% CI, 1.1 – 1.4), and 40% longer duration versus JAK inhibitors (HR, 1.4; 95% CI, 1.2 – 1.7).

“Among Medicare beneficiaries with seropositive RA, those on abatacept were more often persistent to their index treatment and had longer time to treatment discontinuation at 1 year compared to patients on TNF inhibitors or JAK inhibitors which may be reflective of treatment efficacy,” investigators concluded.

The study, “Treatment Persistence Among Medicare Beneficiaries with Seropositive Rheumatoid Arthritis Initiating Biologic or Targeted Synthetic DMARDs,” was presented at ACR 2021.