Uptake and Clinical Utility of Multibiomarker Disease Activity Testing in the United States.

Abstract

OBJECTIVE:

The clinical utility of the multibiomarker disease activity (MBDA) test for rheumatoid arthritis (RA) management in routine care in the United States has not been thoroughly studied.

METHODS:

Using 2011-2015 Medicare data, we linked each patient with RA to their MBDA test result. Initiation of a biologic or Janus kinase (JAK) inhibitor in the 6 months following MBDA testing was described. Multivariable adjustment evaluated the likelihood of adding or switching biologic/JAK inhibitor, controlling for potential confounders. For patients with high MBDA scores who added a new RA therapy and were subsequently retested, lack of improvement in the MBDA score was evaluated as a predictor of future RA medication failure, defined by the necessity to change RA medications again.

RESULTS:

Among 60,596 RA patients with MBDA testing, the proportion adding or switching biologics/JAK inhibitor among those not already taking a biologic/JAK inhibitor was 9.0% (low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Similarly, among those already taking biologics/JAK inhibitor, the proportions were 5.2%, 8.3%, and 13.5% (p < 0.0001). After multivariable adjustment, referent to those with low disease MBDA scores, the likelihood of switching was 1.51-fold greater (95% CI 1.35-1.69) for patients with moderate MBDA scores, and 2.62 (2.26-3.05) for patients with high MBDA scores. Among those with high MBDA scores who subsequently added a biologic/JAK inhibitor and were retested, lack of improvement in the MBDA score category was associated with likelihood of future RA treatment failure (OR 1.61, 95% CI 1.27-2.03).

CONCLUSION:

The MBDA score was associated with both biologic and JAK inhibitor medication addition/switching and subsequent treatment outcomes.

• Authors: Jeffrey R Curtis, Fenglong Xie, Shuo Yang, Maria I Danila, Justin K Owensby, Lang Chen
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 46 Issue 3 Pg. 237-244 (03 2019) ISSN: 0315-162X [Print] Canada
• PMID: 30442830 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Biological Products
• Biomarkers
• Janus Kinase Inhibitors

Topics

• Aged
• Aged, 80 and over
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (diagnosis, drug therapy)
• Biological Products (therapeutic use)
• Biomarkers
• Diagnostic Tests, Routine (methods)
• Drug Substitution
• Female
• Follow-Up Studies
• Humans
• Janus Kinase Inhibitors (therapeutic use)
• Male
• Medicare
• Middle Aged
• Severity of Illness Index
• Treatment Outcome
• United States