Tofacitinib Monotherapy Adherence Lower Than Combination Therapy, More Research Needed
More patients also switched from combination therapy to monotherapy at any time in both analyzed database populations.
Philip J Mease, MD
Credit: tregmed.com
Tofacitinib adherence was numerically lower in patients with psoriatic arthritis (PsA) receiving monotherapy compared to those receiving combination therapy with tofacitinib and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).1
“Tofacitinib adherence and persistence, both as monotherapy and in combination with csDMARDs, were recently evaluated over 6 months in a real-world setting in patients with PsA. As a natural follow-up to that study, this current study further describes the analysis of adherence and persistence using a larger sample size and over a longer follow-up, and evaluates costs and healthcare resource utilization (HCRU) in patients with PsA who were treated with tofacitinib as monotherapy and/or in combination with csDMARDs,” lead investigator Philip J Mease, MD, Clinical Professor, University of Washington School of Medicine and Director, Rheumatology Research, Swedish Medical Center, and colleagues wrote.1
Mease and colleagues analyzed claims data from Optum® Clinformatics® Data Mart (OC) and Merative™ MarketScan® (MS) databases between December 2017 and February 2020. They looked at adherence/persistence by therapy type (monotherapy/combination therapy) and HCRU/costs (per patient per month) by periods on-treatment and off-treatment plus therapy type.
The included data were from 274 patients in OC (70.4% female; mean age, 54.4 years) and 395 in MS (68.9% female; mean age, 51.4 years).Within the first 90 days post-index, most patients were receiving monotherapy vs combination therapy (OC, 74.1% vs 25.9%; MS, 65.8% vs 34.2%) but there were fewer female patients receiving monotherapy compared with combination therapy (67.0% vs 80.3%) in OC. Less patients in the monotherapy cohorts had Medicare insurance (OC, 19.7% vs 31.0%; MS, 4.6% vs 5.9%) this cohort also had shorter follow-up periods (OC, 24.4 months [IQR, 16.6] vs 28.7 [IQR, 14.8]; MS, 14.3 months [IQR, 10.6] vs 16.6 [12.2]). More patients also switched from combination therapy to monotherapy at any time in both database populations.1
The investigators found that at 12 months, 44.5% of patients receiving monotherapy and 53.8% receiving combination therapy in OC had good adherence (Medication possession ratio [MPR] ≥ 0.8) to tofacitinib,and 36.4% of patients receiving monotherapy and 45.7% receiving combination therapy in MS had good adherence. These trends, while not statistically significant, continued at 24 months. Patients receiving monotherapy had a median time to treatment discontinuation of 10.1 months (95% CI, 7.4-11.8) and those receiving combination therapy had a median time to treatment discontinuation of 16.7 months (95% CI, 8.3-26.6) in OC. In MS, patients receiving monotherapy had a median time to treatment discontinuation of 6.9 months (95% CI, 5.6-9.4) and those receiving combination therapy had a median time to treatment discontinuation of 11.0 months (95% CI, 6.1-13.9).1
All-cause and PsA-related costs were accordingly decreased during off-treatment compared with on-treatment periods regardless of therapy type. During off-treatment periods, outpatient visits increased for all-cause (OC, 2.37 vs 2.05; MS, 2.15 vs 1.99) and PsA-related visits (OC, 0.60 vs 0.46; MS, 0.47 vs 0.44) compared with on-treatment periods. PsA-related medication use also numerically decreased (OC, 1.21 vs 1.53; MS, 1.05 vs 1.48) during off-treatment periods.1
“This study provided further understanding of tofacitinib use in patients with PsA in a real-world setting; however, studies investigating patient characteristics could help to determine the main factors associated with tofacitinib economic burden and compliance,” Mease and colleagues wrote.1
Other recent research published for PsA found that in a cohort of French patients, initiating targeted therapy for PsA reduced the use of associated symptomatic treatment and healthcare consumption. After initiating targeted therapies, the use of non-steroidal anti-inflammatory drugs (NSAIDs; -15%), opioid analgesics (−9%), prednisone (−9%), methotrexate (−15%) and mood disorder treatments (−2%) was decreased. Hospitalizations (−12%) and sick leaves (−4%) also decreased.2
