Patient Support Programs Associated With Greater Adherence to Adalimumab Therapy

Biologic drug developers often provide free-to-patient support programs (PSP) that assist patients with drug costs, injection training, or nurse support, but the impact of such programs for patients receiving adalimumab has not been assessed in the past. A recently published study sought to quantify the relationship between participation in a patient program and outcomes in patients who were initiating treatment with adalimumab.

The longitudinal, retrospective cohort study, funded by AbbVie (makers of the reference adalimumab, Humira), found that enrollment in patient support programs (PSP) was associated with greater adherence, improved persistence, and reduced medical and total healthcare costs for patients who were receiving adalimumab therapy.

The study used patient-level data derived from the Humira PSP and the Symphony Health Solutions’ administrative claims data for patients who initiated adalimumab treatment between January 2008 and June 2014. The enrolled patients were being treated for Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis, and all were naïve to biologic treatment before initiating adalimumab.

Of the 2386 patients included in the study, 1199 patients were in the PSP cohort and 1187 in the non-PSP cohort. All patients were required to have evidence of medical and pharmacy coverage from at least 6 months before and after their first adalimumab claim and at least 12 months after an index date (which was assigned as the earliest date of PSP enrollment. Time to enrollment following treatment initiation was used to assign index dates to the non-PSP cohort).

The researchers found the following:

• Adalimumab adherence was 14% greater in the PSP cohort than the non-PSP cohort during the follow-up period (mean: 67.0% and 58.8%, respectively)
• The discontinuation rate for adalimumab was 14% lower in the PSP cohort than the non-PSP cohort (mean: 39.7% and 46.2%, respectively)
• Patients in the PSP cohort had 23% lower 12-month medical costs (excluding the cost of biologic therapy) than the non-PSP cohort (mean: $18,322 and $23,679, respectively)
• Disease-related medicals costs were 10% lower for the PSP cohort than the non-PSP cohort (mean: $35,741 and $39,713, respectively)

The authors concluded that PSP enrollment was associated with greater adherence, improved persistence, and reduced medical and total healthcare costs for patients who were receiving adalimumab therapy. These findings are important, they say, because existing evidence shows rates of nonadherence to anti-tumor necrosis factor therapies exceeds 40%; nonadherence limits effectiveness, is associated with poor clinical outcomes, and creates a substantial economic burden. While no consistent risk factors for nonadherence have been identified, evidence suggests that support programs increase adherence to chronic therapy regimens.

The authors also suggest that their data provide support for prescribing physicians to encourage patients to enroll in PSPs, as well as for pharmaceutical companies to further develop and invest in such programs.