The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy.

Abstract

BACKGROUND:

There are numerous non-biologic and biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice.

METHODS:

We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every 6 months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use.

RESULTS:

7300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. Eighty-two percent of TCZm use began within 3 years of starting any bDMARD. Ninety-three percent of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with the use of TCZm included prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor.

CONCLUSIONS:

Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

• Authors: Daniel H Solomon, Chang Xu, Jamie Collins, Seoyoung C Kim, Elena Losina, Vincent Yau, Fredrik D Johansson
• Journal: Arthritis research & therapy (Arthritis Res Ther) Vol. 23 Issue 1 Pg. 26 (01 14 2021) ISSN: 1478-6362 [Electronic] England
• PMID: 33446261 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Biological Products
• tocilizumab

Topics

• Aged
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Biological Products (therapeutic use)
• Female
• Humans
• Male
• Middle Aged