Pattern and predictors of the initiation of biologic agents for the treatment of rheumatoid arthritis in the United States: An analysis using a large observational data bank

doi:10.1016/j.clinthera.2009.08.020

Clinical Therapeutics

Volume 31, Issue 8, August 2009, Pages 1871-1880

https://doi.org/10.1016/j.clinthera.2009.08.020 Get rights and content

Abstract

Objective: The aim of this study was to identify factors associated with the initiation of biologic agents for the treatment of rheumatoid arthritis (RA) in a large US observational cohort.

Methods: Semiannual patient-reported data in the ARAMIS (Arthritis, Rheumatism and Aging Medical Information System) data bank from January 1998 to January 2006 were analyzed retrospectively using pooled logistic regression (with adjustment for center-level and temporal effects) to identify patient-, disease-, and treatment-related characteristics associated with the initiation of biologics for the treatment of RA.

Results: The analysis included 1545 patients from 7 US centers. By 2006, 41.4% of 679 patients remaining in the sample had received biologics. Initiation of biologics was significantly associated with greater disability in the previous 6-month period (per 1-unit increase in Health Assessment Questionnaire score: odds ratio [OR] = 1.45; 95% CI, 1.22–1.72; P < 0.01) and treatment in the previous period with steroids (OR = 2.24; 95% CI, 1.76–2.85; P < 0.01) or nonbiologic disease-modifying antirheumatic drugs (OR = 2.43; 95% CI, 1.71–3.46; P < 0.01). Two sociodemographic factors were significant predictors of decreased use of biologics: older age (per 10 years: OR = 0.74; 95% CI, 0.660.82; P < 0.01) and lower annual income (per $10,000 reduction: OR = 0.95; 95% CI, 0.91–1.00; P = 0.04). There were no significant differences with respect to sex, race, employment status, comorbidity, previous NSAID use, or treatment center.

Conclusions: Disease- and treatment-related factors were significant predictors of the initiation of biologics for RA. Independent of these factors, however, biologics were less often used in patients who were older and those with lower incomes. Use of biologics increased steadily over the period studied.

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Pattern and predictors of the initiation of biologic agents for the treatment of rheumatoid arthritis in the United States: An analysis using a large observational data bank

Abstract

Lancet Infect Dis

Best Pract Res Clin Rheumatol

An overview of economic evaluations for drugs used in rheumatoid arthritis: Focus on tumour necrosis factor-alpha antagonists

Drugs

Use of biologics for rheumatoid arthritis tempered by concerns over safety, cost

JAMA

Guidelines for the management of rheumatoid arthritis: 2002 Update

Arthritis Rheum

FDA approved drug products

The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: A systematic review and metaanalysis

J Rheumatol

The efficacy of inhibiting tumour necrosis factor alpha and interleu-kin 1 in patients with rheumatoid arthritis: A meta-analysis and adjusted indirect comparisons

Rheumatology (Oxford)

Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: Systematic review and meta-analysis of rare harmful effects in randomized controlled trials [published correction appears in JAMA. 2006;295:2482]

JAMA

Case reports of heart failure after therapy with a tumor necrosis factor antagonist

Ann Intern Med

Tolerance and effectiveness of anti-tumor necrosis factor alpha therapies in elderly patients with rheumatoid arthritis: A population-based cohort study

Arthritis Rheum

Do patients with older-onset rheumatoid arthritis receive less aggressive treatment?

Ann Rheum Dis

Treatment of older adult patients diagnosed with rheumatoid arthritis: Improved but not optimal

Arthritis Rheum

Does age bias the aggressive treatment of elderly patients with rheumatoid arthritis?

J Rheumatol

Medicare coverage of tumor necrosis factor alpha inhibitors as an influence on physicians' prescribing behavior [published correction appears in Arch Intern Med. 2006;166:954]

Arch Intern Med

The effect of race and sex on physicians' recommendations for cardiac catheterization [published correction appears in N Engl J Med. 1999;340:1130]

N Engl J Med