Insurance Data Show Increasing Use of Biologic DMARDs

Ten biologic disease-modifying antirheumatic drugs (bDMARDs) are approved by the FDA for the treatment of rheumatoid arthritis (RA): infliximab, etanercept, adalimumab, certolizumab, golimumab, tocilizumab, anakinra, abatacept, rituximab, and tofacitinib. However, there are few data on trends in their use in both publicly and privately insured patients. These trends were recently examined and described in a research brief published in the Journal of Managed Care & Specialty Pharmacy. The brief states that there was a steady increase in the use of bDMARDs for patients with RA, especially among Medicaid-enrolled patients, over the 15-year study period.

Etanercept remains the most frequently used agent (accounting for approximately 50% of all biologic initiations). However, use of adalimumab and infliximab is decreasing, and the use of newer agents—especially abatacept, golimumab, and certolizumab—has risen considerably in recent years; these 3 drugs are now used in approximately 1 in 4 initiations and 2 in 5 switches. The investigators conclude that their findings show the need for further comparative safety and efficacy research of these newer agents to better guide evidence-based decision making.

The study, conducted by Rishi J. Desai, MS, PhD, and colleagues, used claims data from private and public insurance programs for the years 2000 through 2015. There study included 113,031 patients with RA who had public insurance and 97,751 who had private insurance. Rates of initiation of bDMARDs per 100 patients increased significantly over time in the Medicaid data for incident patients (those with only 1 RA visit and no DMARD use in the pre-index period), from 1.1 to 3.1 (P = .0006) and prevalent patients (those with more than 1 RA visit or use of non-bDMARD treatments in the pre-index period, from 4.6 to 10.9 (P = .008). In privately insured patients, the rates were stable, with 7.7 to 8.3 per 100 incident patients (P = .10) and 11.0 to 11.5 per 100 prevalent patients (P = .12). Rates of switching per 100 patients increased over time from 6.4 to 16.0 (P = .04) in Medicaid patient data and 9.1 to 17.0 (P = .00003) in privately insured patient data.

The study authors note that their findings are limited by the unavailability of disease activity data, which may have hampered their ability to completely account for the changing patient-case mix over the years. In addition, the data do not contain information on prescriptions that were written but never filled. “Therefore, our findings may not completely represent physician practice patterns and should be interpreted as trends in dispensing of bDMARDs,” they note. “The increase in use of bDMARDs may be attributable to a greater number of treatment options available, from 3 in 2002 to 10 since 2012, as well as increasing experiences and familiarity of physicians with these agents.”