Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Impact of Comorbidities on TNF Inhibitor Persistence in Rheumatoid Arthritis Patients: An Analysis of Korean National Health Insurance Claims Data.
Cho1, Soo-Kyung, Sung1, Yoon-Kyoung, Choi2, Chan-Bum, Kim3, Jae Hoon, Kim4, Jin Ju, Lee4, Joo-Hyun, Joo4, Young Bin
Hanyang University Hospital for Rheumatic Diseases, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
Hanyang University Hospital for Rheumatic Disease, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
Hanyang University Hospital for Rheumatic Disease, Seoul, South Korea
Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
Background/Purpose:
The tumor necrosis factor (TNF) inbibitors have been shown to be effective in treating rheumatoid arthritis (RA) in several randomized controlled trials (RCTs). However, patients with RA in clinical practice might be different from those patients selected for clinical trials; for example, they may have different comorbidities, economic problems, and be taking other drugs at the same time. These differences may influence the efficacy and safety profile of TNF inhibitors. Comorbidity in particular increases the complexity of patient care and makes treatment decisions more challenging. Therefore, in clinical practice, it is important to recognize such comorbidities in RA patients and to consider them before initiating TNF inhibitor treatment. We conducted this study to evaluate TNF inhibitor persistence and the impact of comorbidity on treatment persistence in patients with RA.
Methods:
In a Korean National Health Insurance claims database, patients with a diagnosis code of RA (M05 or M06) who started TNF inhibitor therapy between July 1, 2007 and June 30, 2008were enrolled. The study cohort was followed until December 31, 2009. Persistence was examined using Kaplan-Meier survival analysis, and multivariate Cox proportional hazard models were developed to examine the potential impact of comorbidities on drug persistence.
Results:
A total of 388 patients were enrolled in the study cohort. The mean persistence rate in the overall population was 61% at 18 months. Drug survival rates for adalimumab and etanercept at 6 months were 82% and 85%, respectively, and 73% and 78%, respectively, at 12 months. Charlson comorbidity index (CCI) scores and comorbidities such as diabetes, chronic pulmonary disease, mild liver disease, and depression at initiation were not related with drug persistence, while peptic ulcer disease (PUD) lowered the risk of discontinuation of TNF inhibitors (HR 0.73, 95% CI: 0.55 to 0.97). Old age (HR 1.59, 95% CI: 1.09 to 2.33) and prescription of inhibitors by an internist (HR 1.59, 95% CI: 1.02 to 2.48) were other factors associated with early discontinuation of TNF inhibitors.
Conclusion:
The persistence rate of TNF inhibitors was 61% at 18 months. CCI score and other comorbidities were not related with early discontinuation of TNF inhibitors, while PUD was an independent contributing factor to TNF inhibitor persistence.
To cite this abstract, please use the following information:
Cho, Soo-Kyung, Sung, Yoon-Kyoung, Choi, Chan-Bum, Kim, Jae Hoon, Kim, Jin Ju, Lee, Joo-Hyun, et al; Impact of Comorbidities on TNF Inhibitor Persistence in Rheumatoid Arthritis Patients: An Analysis of Korean National Health Insurance Claims Data. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2223
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