Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort

Stephanie Harvard; Daphne Guh; Nick Bansback; Pascal Richette; Alain Saraux; Bruno Fautrel; Aslam H Anis

doi:10.3899/jrheum.161399

Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort

J Rheumatol. 2017 Oct;44(10):1436-1444. doi: 10.3899/jrheum.161399. Epub 2017 Jul 1.

Authors

Stephanie Harvard^{1

2}, Daphne Guh^{1

2}, Nick Bansback^{1

2}, Pascal Richette^{1

2}, Alain Saraux^{1

2}, Bruno Fautrel^{1

2}, Aslam H Anis^{3

4}

Affiliations

¹ From the School of Population and Public Health, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Sorbonne Universités, UPMC - GRC08, Pierre Louis Institute for Epidemiology and Public Health; University Paris Diderot, Faculty of Medicine; AP-HP, Rheumatology Department, Lariboisiere University Hospital; AP-HP, Rheumatology Department, Pitié Salpétrière University Hospital, Paris; Rheumatology Unit, Hôpital de la Cavale Blanche; EA2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGO, Brest, France.
² S. Harvard, MSc, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, and Sorbonne Universités, UPMC - GRC08, Pierre Louis Institute for Epidemiology and Public Health; D. Guh, MSc, Centre for Health Evaluation and Outcome Sciences; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences; P. Richette, MD, PhD, University Paris Diderot, Faculty of Medicine, and AP-HP, Rheumatology Department, Lariboisiere University Hospital; A. Saraux, MD, PhD, Rheumatology Unit, Hôpital de la Cavale Blanche, and EA2216, INSERM ESPRI, ERI29, Université de Brest; B. Fautrel, MD, PhD, Sorbonne Universités, UPMC - GRC08, Pierre Louis Institute for Epidemiology and Public Health, and AP-HP, Rheumatology Department, Pitié Salpétrière University Hospital; A.H. Anis, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences.
³ From the School of Population and Public Health, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Sorbonne Universités, UPMC - GRC08, Pierre Louis Institute for Epidemiology and Public Health; University Paris Diderot, Faculty of Medicine; AP-HP, Rheumatology Department, Lariboisiere University Hospital; AP-HP, Rheumatology Department, Pitié Salpétrière University Hospital, Paris; Rheumatology Unit, Hôpital de la Cavale Blanche; EA2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGO, Brest, France. aslam.anis@mail.ubc.ca.
⁴ S. Harvard, MSc, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, and Sorbonne Universités, UPMC - GRC08, Pierre Louis Institute for Epidemiology and Public Health; D. Guh, MSc, Centre for Health Evaluation and Outcome Sciences; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences; P. Richette, MD, PhD, University Paris Diderot, Faculty of Medicine, and AP-HP, Rheumatology Department, Lariboisiere University Hospital; A. Saraux, MD, PhD, Rheumatology Unit, Hôpital de la Cavale Blanche, and EA2216, INSERM ESPRI, ERI29, Université de Brest; B. Fautrel, MD, PhD, Sorbonne Universités, UPMC - GRC08, Pierre Louis Institute for Epidemiology and Public Health, and AP-HP, Rheumatology Department, Pitié Salpétrière University Hospital; A.H. Anis, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences. aslam.anis@mail.ubc.ca.

PMID: 28668809
DOI: 10.3899/jrheum.161399

Abstract

Objective: To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indifférenciées Récentes).

Methods: Using alternate definitions of adherence, patients were classified as adherent "timely" anti-TNF users, nonadherent "late" anti-TNF users, adherent nonusers ("no anti-TNF need"), non-adherent nonusers ("unmet anti-TNF need"). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a γ-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes.

Results: Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54-1.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44-1.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06-2.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (-0.04, 95% CI -0.07 to -0.01, p = 0.016).

Conclusion: The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.

Keywords: ADHERENCE; ANKYLOSING SPONDYLITIS; ANTI-TNF; ECONOMIC; QUALITY OF LIFE; SPONDYLOARTHRITIS.

MeSH terms

Adult
Antirheumatic Agents / therapeutic use*
Biological Products / therapeutic use*
Cohort Studies
Female
Humans
Male
Medication Adherence*
Middle Aged
Spondylarthritis / drug therapy*
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Young Adult

Substances

Antirheumatic Agents
Biological Products
Tumor Necrosis Factor-alpha