Purpose: To report real-world utilization patterns of subcutaneous anti-TNF agents as observed in a large, national commercial payer dataset of patients diagnosed with RA.
Methods: Using Optum Insight Clinformatics dataset, adult patients (aged ≥18 years) exhibiting ≥2 claims with an RA diagnoses (ICD-9: 714.xx), ≥24 months of continuous medical and pharmacy eligibility, and 30-day supplies of either adalimumab (ADA), etanercept (ETA) or golimumab (GLM) biologic medication were selected for analyses. Utilization measures including monthly dose, prevalence of dose escalation, proportion of compliant fills, refill interval, proportion of patients with a medication possession ratio (MPR)>0.80, and proportion of patients with ≥4 late refills were compared across treatment groups.
Results: A total of 1,532 ADA, 2,099 ETA, and 261 GLM patients met inclusion criteria. Compared to both ADA and ETA patients, GLM patients were significantly more likely to have an MPR ≥0.80, and significantly less likely to show ≥ 4 late fills (p's < .001). Both GLM and ETA patients were significantly less likely to show an increase in dose compared to ADA patients (p's < .001). Compared to GLM and ADA patients, ETA patients had significantly greater refill intervals, and had the smallest proportion of compliant fills during their episode of care (p's < .001).
| ADA | ETA | GLM |
| |||
Sample Size | 1,532 | 2,099 | 261 |
| |||
Total Fills | 28,043 | 40,642 | 3,407 |
| |||
Recommended . Monthly Dose | 80 mg | 200 mg | 50 mg |
| |||
| M/f | SD/% | M/f | SD/% | M/f | SD/% | p |
Age (years) | 50.7 | 11 | 51.4 | 11 | 50.6 | 11 | 0.176 |
Female | 1157 | 75.5% | 1572 | 74.9% | 211 | 80.8% | 0.108 |
Monthly Dose (mg) | 87.0 | 20.2 | 193.3 | 24.7 | 52.2 | 10.5 | 0.000 |
Dose Escalation (%) | 254 | 16.6% | 92 | 4.4% | 18 | 6.9% | 0.000 |
Refill Interval (days) | 35.1 | 9.3 | 37.7 | 12 | 34.9 | 8 | 0.000 |
MPR ≥0.80 (%) | 1080 | 70.5% | 1298 | 61.8% | 214 | 82.0% | 0.000 |
Compliant Fills | 0.75 | 0.2 | 0.70 | 0.2 | 0.77 | 0.2 | 0.000 |
≥ 4 late fills (%) | 271 | 17.7% | 547 | 26.1% | 18 | 6.9% | 0.000 |
Conclusion: There were a number of statistically significant utilization differences across treatment groups. Golimumab use was associated with higher proportion of patients achieving an MPR ≥0.80 and a lower proportion of patients with ≥ 4 late fills during the study period as compared to other subcutaneous anti-TNF medications. The implications on medication adherence and patient outcomes of these findings require further exploration.