Rheumatoid arthritis (RA) has a considerable economic burden, and costly biologic drugs, including anti–tumor necrosis factor (TNF) agents, are often prescribed in cases in which patients fail to respond adequately to methotrexate.
Rheumatoid arthritis (RA) has a considerable economic burden, and costly biologic drugs, including anti—tumor necrosis factor (TNF) agents, are often prescribed in cases in which patients fail to respond adequately to methotrexate.
However, a high rate of inadequate response to anti-TNFs in patients initiating biologic treatment can result in patients switching—or “cycling”—to alternative anti-TNF products. This cycling can be associated with reduced efficacy and the increased likelihood of switching to an a non—anti-TNF biologic, and may not represent a cost-effective strategy.
A recent study, funded by Pfizer, sought to assess whether tofacitinib, an oral Janus kinase inhibitor administered twice daily at a dose of 5 mg, could represent a cost-effective second-line treatment after methotrexate, third-line treatment after methotrexate and 1 anti-TNF drug, or fourth-line treatment after methotrexate and 2 anti-TNF drugs.
In total, 1321 patients were included in the analysis. The researchers used a decision-tree economic model to evaluate costs over a 2-year time horizon, with treatment response modeled on the American College of Rheumatology’s 20%, 50%, and 70% response criteria (ACR20/50/70). Response rates at 6-month intervals were derived from US prescribing information for monotherapy and combination therapy. Patients with an inadequate response to methotrexate entered the model and initiated treatment with tofacitinib, adalimumab, or etanercept. Drug costs were derived from January 2017 wholesale acquisition costs and approved dosing schedules. Other costs were derived from 2016 data.
The researchers found that:
The researchers concluded that total 2-year costs and PMPM costs were lowest when tofacitinib was used as second-line treatment after methotrexate. “A treatment strategy with introduction of tofacitinib early in the sequence, as either second- or third-line therapy after [methotrexate], may be a lower-cost treatment option when compared with fourth-line introduction of tofacitinib,” write the authors.
Claxton L, Taylor M, Soonasra A, Bourret JA, Gerber RA. An economic evaluation of tofacitinib treatment in rheumatoid arthritis after methotrexate or after 1 or 2 TNF inhibitors from a US payer perspective. J Manag Care Spec Pharm. 2018;13:1-8. doi: 10.18553/jmcp.2018.17220.