Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis
Background: Advances in Disease-Modifying Antirheumatic Drugs (DMARDs) have expanded the treatment landscape for Rheumatoid Arthritis (RA). Guidelines recommend adding either conventional synthetic (cs), biologic (b), or targeted synthetic (ts) DMARDs to methotrexate (MTX) for managing RA. Limited e...
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| Format: | Article |
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Elsevier
2023-09-01
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| Series: | Exploratory Research in Clinical and Social Pharmacy |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266727662300077X |
| _version_ | 1827793929140961280 |
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| author | Yinan Huang Satabdi Chatterjee Sandeep K. Agarwal Hua Chen Michael L. Johnson Rajender R. Aparasu |
| author_facet | Yinan Huang Satabdi Chatterjee Sandeep K. Agarwal Hua Chen Michael L. Johnson Rajender R. Aparasu |
| author_sort | Yinan Huang |
| collection | DOAJ |
| description | Background: Advances in Disease-Modifying Antirheumatic Drugs (DMARDs) have expanded the treatment landscape for Rheumatoid Arthritis (RA). Guidelines recommend adding either conventional synthetic (cs), biologic (b), or targeted synthetic (ts) DMARDs to methotrexate (MTX) for managing RA. Limited evidence exists regarding the factors that contribute to adding a DMARD agent to the MTX regimen. This study examined the factors associated with adding the first DMARD in RA patients initiating MTX. Methods: This retrospective cohort study utilized the MarketScan data (2012–2014) involving adults (aged ≥18) with RA initiating an MTX (index date) between Jul 1, 2012 and Dec 30, 2013, and with continuous enrollment for the 6-month pre-index period. The combination therapy users received the first treatment addition of DMARD starting from day 30 after the index MTX over one year period. The study focused on the addition of csDMARDs, Tumor Necrosis Factor Inhibitors (TNFi) bDMARDs, non-TNFi bDMARDs, or tsDMARDs. Baseline covariates were measured in the 6-month pre-index and grouped into predisposing, enabling, and need factors, as per the Andersen Behavior Model. Multivariable logistic regression examined the factors associated with the addition of TNFi compared to adding a csDMARD. An additional regression model evaluated the factors associated with adding any biologic (combining TNFi and non-TNFi biologics). Results: Among 8350 RA patients starting MTX, 31.92% (n = 2665) initiated any DMARD within the 1-year post-index period. Among RA patients initiating a DMARD prescription after starting MTX, 945 (11.32%) received combination therapy with treatment addition of a DMARD to MTX regimen; majority added TNFi (550, 58%), followed by csDMARD (352, 37%); non-TNF biologic (40, 4%), or tsDMARD (3, 0.3%). The tsDMARD group was limited and was not included for further analysis. The multivariable model found Preferred Provider Organization insurance coverage (odds ratio [OR], 1.43; 95% confidence interval (CI), 1.06–1.93), chronic pulmonary disease (OR, 1.98; 95% CI, 1.14–3.44), liver disease (OR, 5.24; 95% CI, 1.77–15.49), and Elixhauser score (OR, 0.91; 95% CI, 0.86–0.97) were significantly associated with the addition of TNF-α inhibitors. The separate multivariable model additionally found that patients from metropolitan areas (OR, 1.50; 95% CI, 1.04–2.16) were positively associated with adding any biological agent. Conclusions: TNFi are often added to MTX for managing RA. Enabling and need factors contribute to the prescribing of a TNFi add-on therapy in RA. Future research should examine the impact of these combination therapies on RA management. |
| first_indexed | 2024-03-11T18:25:35Z |
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| issn | 2667-2766 |
| language | English |
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| spelling | doaj.art-f4f76651c906426f83f9cf56bcfd1c1d2023-10-14T04:45:44ZengElsevierExploratory Research in Clinical and Social Pharmacy2667-27662023-09-0111100296Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritisYinan Huang0Satabdi Chatterjee1Sandeep K. Agarwal2Hua Chen3Michael L. Johnson4Rajender R. Aparasu5Department of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of AmericaDepartment of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America; Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States of America; Section of Immunology, Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of AmericaDepartment of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America; Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States of America; Section of Immunology, Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of AmericaDepartment of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America; Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States of America; Section of Immunology, Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of AmericaDepartment of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America; Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States of America; Section of Immunology, Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of AmericaCorresponding author at: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Road, Health & Sciences Bldg 2, Houston, TX 77204, United States of America.; Department of Pharmacy Administration, University of Mississippi, Oxford, MS, United States of America; Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States of America; Section of Immunology, Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of AmericaBackground: Advances in Disease-Modifying Antirheumatic Drugs (DMARDs) have expanded the treatment landscape for Rheumatoid Arthritis (RA). Guidelines recommend adding either conventional synthetic (cs), biologic (b), or targeted synthetic (ts) DMARDs to methotrexate (MTX) for managing RA. Limited evidence exists regarding the factors that contribute to adding a DMARD agent to the MTX regimen. This study examined the factors associated with adding the first DMARD in RA patients initiating MTX. Methods: This retrospective cohort study utilized the MarketScan data (2012–2014) involving adults (aged ≥18) with RA initiating an MTX (index date) between Jul 1, 2012 and Dec 30, 2013, and with continuous enrollment for the 6-month pre-index period. The combination therapy users received the first treatment addition of DMARD starting from day 30 after the index MTX over one year period. The study focused on the addition of csDMARDs, Tumor Necrosis Factor Inhibitors (TNFi) bDMARDs, non-TNFi bDMARDs, or tsDMARDs. Baseline covariates were measured in the 6-month pre-index and grouped into predisposing, enabling, and need factors, as per the Andersen Behavior Model. Multivariable logistic regression examined the factors associated with the addition of TNFi compared to adding a csDMARD. An additional regression model evaluated the factors associated with adding any biologic (combining TNFi and non-TNFi biologics). Results: Among 8350 RA patients starting MTX, 31.92% (n = 2665) initiated any DMARD within the 1-year post-index period. Among RA patients initiating a DMARD prescription after starting MTX, 945 (11.32%) received combination therapy with treatment addition of a DMARD to MTX regimen; majority added TNFi (550, 58%), followed by csDMARD (352, 37%); non-TNF biologic (40, 4%), or tsDMARD (3, 0.3%). The tsDMARD group was limited and was not included for further analysis. The multivariable model found Preferred Provider Organization insurance coverage (odds ratio [OR], 1.43; 95% confidence interval (CI), 1.06–1.93), chronic pulmonary disease (OR, 1.98; 95% CI, 1.14–3.44), liver disease (OR, 5.24; 95% CI, 1.77–15.49), and Elixhauser score (OR, 0.91; 95% CI, 0.86–0.97) were significantly associated with the addition of TNF-α inhibitors. The separate multivariable model additionally found that patients from metropolitan areas (OR, 1.50; 95% CI, 1.04–2.16) were positively associated with adding any biological agent. Conclusions: TNFi are often added to MTX for managing RA. Enabling and need factors contribute to the prescribing of a TNFi add-on therapy in RA. Future research should examine the impact of these combination therapies on RA management.http://www.sciencedirect.com/science/article/pii/S266727662300077XRheumatoid arthritisTumor necrosis factor inhibitor biologicsCombination therapyMethotrexateBiological disease-modifying antirheumatic drugs |
| spellingShingle | Yinan Huang Satabdi Chatterjee Sandeep K. Agarwal Hua Chen Michael L. Johnson Rajender R. Aparasu Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis Exploratory Research in Clinical and Social Pharmacy Rheumatoid arthritis Tumor necrosis factor inhibitor biologics Combination therapy Methotrexate Biological disease-modifying antirheumatic drugs |
| title | Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis |
| title_full | Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis |
| title_fullStr | Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis |
| title_full_unstemmed | Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis |
| title_short | Factors influencing prescribing the first add-on disease-modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis |
| title_sort | factors influencing prescribing the first add on disease modifying antirheumatic drugs in patients initiating methotrexate for rheumatoid arthritis |
| topic | Rheumatoid arthritis Tumor necrosis factor inhibitor biologics Combination therapy Methotrexate Biological disease-modifying antirheumatic drugs |
| url | http://www.sciencedirect.com/science/article/pii/S266727662300077X |
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