Effectiveness of biologics in Australian patients with rheumatoid arthritis: a large observational study: REAL

Dave Nicholls; Rina Barrett; Peter Button; Matt Truman; Paul Bird; Lynden Roberts; Kathleen Tymms; Geoffrey Littlejohn; Hedley Griffiths

doi:10.1111/imj.14028

Effectiveness of biologics in Australian patients with rheumatoid arthritis: a large observational study: REAL

Intern Med J. 2018 Oct;48(10):1185-1192. doi: 10.1111/imj.14028.

Authors

Dave Nicholls¹, Rina Barrett², Peter Button², Matt Truman², Paul Bird³, Lynden Roberts⁴, Kathleen Tymms⁵, Geoffrey Littlejohn⁴, Hedley Griffiths⁶

Affiliations

¹ University of the Sunshine Coast and Coast Joint Care, Rheumatology Research Unit, Maroochydore, Queensland, Australia.
² Roche Products Pty Limited, Medical Affairs, Sydney, New South Wales, Australia.
³ University of New South Wales and Combined Rheumatology Practice, Sydney, New South Wales, Australia.
⁴ Monash University, Monash Rheumatology, Melbourne, Victoria, Australia.
⁵ Canberra Rheumatology, Canberra, Australian Capital Territory, Australia.
⁶ Barwon Rheumatology Service, Geelong, Victoria, Australia.

PMID: 29968400
DOI: 10.1111/imj.14028

Abstract

Background: The comparative effectiveness of biologic treatment regimens in a real world Australian population is unknown.

Aim: To assess the effectiveness of biological disease-modifying anti-rheumatic drugs (bDMARD) as monotherapy or in combination with methotrexate and/or other conventional DMARD (cDMARD) for the treatment of rheumatoid arthritis (RA).

Methods: A retrospective, non-interventional study was conducted that investigated the use of bDMARD in adult patients with RA in routine clinical practice. Data were extracted from the Optimising Patient Outcomes in Australian Rheumatology - Quality Use of Medicines Initiative database. Real-world effectiveness was measured using the 28-joint disease activity score (DAS28) and clinical disease activity index (CDAI) by treatment group at baseline, weeks 12 and 24.

Results: A total of 2970 patients was included with a median (min-max) age of 60.0 (19.0-94.0) years and median (min-max) duration of RA before first bDMARD treatment of 6.0 (0.2-58.3) years. A total of 1177 patients received more than one bDMARD during the analysis period of 1 January 1997 to 15 August 2015. Patients had 4922 treatment 'episodes' (defined as a cycle of continuous individual bDMARD prescribing in a single patient). Patients received a mean (SD) of 1.7 (1.0) episodes of treatment with median (min-max) treatment duration of 0.7 (0-11.8) years; median treatment duration was higher with the first treatment episode. bDMARD were most commonly initiated in combination with methotrexate (73.9% of episodes) and least commonly as monotherapy (9.9% of episodes). Median (min-max) baseline DAS28 decreased from 5.3 (0-8.7) with the first bDMARD to 3.7 (0-8.8) with the second. Median baseline CDAI similarly decreased.

Conclusions: Patients tended to persist longer on their first bDMARD treatment. bDMARD as monotherapy or in combination appear to be accepted treatment strategies in the real world.

Keywords: OPAL-QUMI; biologic DMARD; monotherapy; persistence; rheumatoid arthritis.

Publication types

Comparative Study
Multicenter Study
Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy*
Arthritis, Rheumatoid / epidemiology
Australia / epidemiology
Biological Products / therapeutic use*
Databases, Factual
Drug Administration Schedule
Drug Therapy, Combination
Female
Humans
Male
Methotrexate / therapeutic use*
Middle Aged
Retrospective Studies
Treatment Outcome

Substances

Antirheumatic Agents
Biological Products
Methotrexate

Grants and funding

Roche Products Pty Limited