Changes in Market Share of Biologic and Targeted Synthetic Disease-Modifying Anti-Rheumatic Drugs for Treatment of Rheumatoid Arthritis: Results from the Ontario Best-Practice Research Initiative Database

Elliot Hepworth; Mohammad Movahedi; Emmanouil Rampakakis; Reza Mirza; Arthur Lau; Angela Cesta; Janet Pope; John S Sampalis; Claire Bombardier

doi:10.2174/1573397116666201211130337

Changes in Market Share of Biologic and Targeted Synthetic Disease-Modifying Anti-Rheumatic Drugs for Treatment of Rheumatoid Arthritis: Results from the Ontario Best-Practice Research Initiative Database

Curr Rheumatol Rev. 2021;17(3):349-359. doi: 10.2174/1573397116666201211130337.

Authors

Elliot Hepworth¹, Mohammad Movahedi², Emmanouil Rampakakis³, Reza Mirza⁴, Arthur Lau⁵, Angela Cesta², Janet Pope⁶, John S Sampalis³, Claire Bombardier²

Affiliations

¹ Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
³ JSS Medical Research Inc., St-Laurent, Quebec, Canada.
⁴ Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁶ Divisions of Rheumatology, Epidemiology and Biostatistics, Department of Medicine, Western University, London, ON, Canada.

PMID: 33308132
DOI: 10.2174/1573397116666201211130337

Abstract

Objective: For patients with Rheumatoid Arthritis (RA) who do not achieve adequate clinical response with combined conventional synthetic disease-modifying anti-rheumatic drugs (cs- DMARDs), initiation of advanced therapies such as biologic DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) is recommended. Tumour necrosis factor inhibitors (TNFi) are the oldest and most commonly used subgroup of advanced therapies. In the last decade, new non-TNFi advanced therapy options have become available. We described the relative use of TNFi vs. non-TNFi in Ontario-based practices from 2008-2017.

Methods: Adult patients with RA enrolled in the Ontario Best Practices Research Initiative (OBRI) database who started bDMARDs or tsDMARDs anytime during or within 30 days prior to enrollment were included. The proportion of patients treated with TNFi vs. non-TNFi agents between 2008 and 2017 was described for all patients and those initiating their first bDMARD/tsDMARD. All TNFi therapies were included. Non-TNFi included Abatacept, Rituximab, Tocilizumab, and Tofacitinib.

Results: A total of 1,057 patients were included, of whom 72.0% were bDMARD/tsDMARD naïve. In 2008, the relative non-TNFi use was 5.4% in all patients while it was 0% in bDMARD/ts- DMARD-naïve patients. In 2017, the proportion of patients using non-TNFi increased to 33.8% among all patients and 33.3% in bDMARD/tsDMARD-naïve patients.

Conclusion: This descriptive analysis of data from the OBRI cohort reveals that TNFi are still used in the majority of cases; however, there has been an increase in the use of non-TNFi therapies both overall and as first-line advanced therapy. This trend towards non-TNFi therapies as first-line advanced therapy may be partially explained by the shift in guideline recommendations from TNFi as first-line to any of the advanced therapeutics.

Keywords: Biologic; anti-rheumatic drugs; bDMARDs; rheumatoid arthritis; targeted synthetic disease; treatment; tsDMARDs..

MeSH terms

Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / drug therapy
Biological Products* / therapeutic use
Databases, Factual
Humans
Ontario

Substances

Antirheumatic Agents
Biological Products