(98) Primary Non-Adherence to Biologics and Immunomodulatory Therapies for Rheumatoid Arthritis, Psoriatic Arthritis, and Spondyloarthritis Using Linked EHR and Pharmacy Claims Data

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1143

Presenting Author(s)

Jeffrey R. Curtis, MPH, MD, MS
– Professor of Medicine, Epidemiology, and Computer Science, University of Alabama Birmingham, University of Alabama at Birmingham, Birmingham, Alabama, United States

Co-Author(s)

Yujie su
– UAB, United States
Cassie Clinton
– UAB, United States
Patrick Stewart
– BendCare, United States
bryant England
– University of Nebraska Medical Center, United States
Fenglong Xie
– University of Alabama at Birmingham, United States

Background: Many patients with autoimmune and inflammatory conditions discontinue biologics and other immunomodulatory medications prematurely, but many fail to even start. We examined primary non-adherence in a national rheumatology EHR data warehouse linked to pharmacy claims data.

Objectives: To examine primary non-adherence of autoimmune medications in a national rheumatology EHR data warehouse linked to pharmacy claims data.

Methods: We identified new users of TNFi and non-TNFi biologics, conventional and targeted synthetic DMARDs used for rheumatoid, psoriatic, or spondyloarthritis in the Illumination Health Real-World Evidence Platform linked to fee-for-service Medicare or commercial health plan claims data. Patients with new prescriptions identified in the EHR data were compared to the gold standard of actual fills or administrations in linked claims data at 3 and 6 months. We examined factors associated with non-adherence using KM curves and estimated hazard ratios (HRs) from Cox proportional hazards models, comparing oral and subcutaneous (SQ) medications to intravenous TNFi (TNF-IV).

Results: In Medicare, 858 patients were prescribed 1097 immunomodulatory medications, with mean (SD) age 67 (11) years. Similarly, 395 commercially-insured patients initiated 522 medications, mean(SD) age 63(13) years. Approximately 60% had RA. The most common newly prescribed medications were csDMARDs(Medicare: 51%; commercial: 51%), TNFi (Medicare:15%; commercial: 16%), non-TNFi biologics (Medicare:21%; commercial: 21%), and Janus kinase inhibitors [JAKi] (Medicare: 13%; commercial: 12%). Following the first prescription in the EHR data and within the next 3 months, patients frequently did not fill the prescribed medication (Medicare: 37%; commercial: 46%) or any new immumomodulatory medication (Medicare: 25%; commercial: 38%). Results were minimally better at 6 months for the prescribed medication (Medicare: 36%; commercial: 43%) or any new medication (Medicare: 22%; commercial: 36%).

After multivariable adjustment, and referent to TNFi-IV, medication class was significantly associated with primary non-adherence (Medicare: TNFi-SQ HR: 2.1, 95% CI 1.25-3.3; non-TNFi IV: HR 3.6, 2.1-5.9; non-TNFi SQ: HR 3.8, 2.3-6.7; tsDMARDs: HR 3.8, 2.3-6.3; csDMARDs: HR 1.1, 0.7-1.7; commercial: TNFi-SQ HR: 0.8, 95% CI 0.3-2.1; non-TNFi IV: HR 1.3, 0.4-4.1; non-TNFi SQ: HR 2.6, 1.0-7.1; tsDMARDs: HR 1.0, 0.4-2.6; csDMARDs: HR 0.4, 0.2-1.0).

Conclusions: Patients with RA, PsA, or SpA frequently did not fill newly prescribed biologics and immunomodulatory medications prescribed by their rheumatologist. Approaches to quickly detect this non-adherence shortly after prescribing are needed to maximize the benefits of early initiation of these therapies.