Switching to Biologics With Different Mechanisms of Action Reduces Cost in Patients With RA

Patients with rheumatoid arthritis (RA) who require a change in therapy from anti—tumor necrosis factor inhibitor (anti-TNF) treatments to biologics with a different mechanism of action (MOA) had higher treatment persistence and lower healthcare costs than patients who cycled anti-TNF drugs, resulting in lower healthcare costs per persistent patient among the MOA switchers, a recent study finds.

“MOA switching is associated with economic and clinical advantages for RA patients and their health plans when a change in therapy is required,” Benjamin Chastek, MS, and colleagues conclude, and said that reimbursement policies requiring patients to cycle anti-TNF products before switching to a different MOA may end up resulting in suboptimal outcomes for both patients and payers. The findings were published in Advances in Therapy.

Recent RA treatment guidelines recommend that, if disease activity remains moderate or high despite monotherapy with disease-modifying antirheumatic drugs (DMARDs), patients should be switched to a drug with a different MOA earlier in the treatment paradigm. Guidelines now recommend other MOA therapies either as an alternative option to an anti-TNF drug for first-line biological therapy, or as an option for second-line therapy after failure of an anti-TNF drug instead of cycling to another anti-TNF option. Although these guidelines are supported by evidence of improved treatment persistence, clinical outcomes, and lower costs after switching to a different MOA compared with anti-TNF drug cycling, cycling remains more common than MOA switching in clinical practice.

The researchers studied claims data of patients with RA and at least 1 claim for an anti-TNF therapy (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) between January 2012 and September 2015 who changed to another anti-TNF agent or a different MOA therapy (abatacept, tocilizumab, or tofacitinib) within 1 year.

From among a study population of 1516 patients, they identified 581 MOA switchers and 935 anti-TNF cyclers. Treatment persistence was defined as no subsequent switch or a 60-day gap in therapy for 1 year. RA-related costs included plan-paid and patient-paid amounts for inpatient, outpatient, and pharmacy claims; medication costs included index and post-index costs of anti-TNF drugs and different MOA therapies. The study did not examine outcomes for individual medications within each class.

The study found the following:

• The treatment persistence rate was significantly higher for MOA switchers versus anti-TNF cyclers (47.7% versus 40.2%; P =.004).
• Mean 1-year healthcare costs were significantly lower among MOA switchers versus anti-TNF cyclers for total RA-related costs ($37,804 versus $42,116; P <.001) and medication costs ($29,001 versus $34,917; P <.001).
• Costs per persistent patient were lower among MOA switchers versus anti-TNF cyclers: $25,436 lower total RA-related costs and $25,999 lower medication costs.

Switching to a different MOA may lower not only the non-drug healthcare costs, but also drug costs compared with anti-TNF cycling because the observed difference in mean RA-related costs was driven largely by lower targeted DMARD costs among MOA switchers versus anti-TNF cyclers. “Consistent findings for treatment persistence across different patient populations may have clinical implications for the management of RA, because greater treatment persistence and adherence have been reported to improve clinical outcomes in RA,” the researchers note.

Because RA treatment guidelines were updated after the study period, more study is needed to determine whether these recent changes to the guidelines will influence clinical practice and lead to increased use of different MOA therapies compared with anti-TNF drugs.

The research was supported by Sanofi and Regeneron Pharmaceuticals.