Real‐World Use of Biologic and Targeted Synthetic Disease‐Modifying Antirheumatic Drugs in Patients With Axial Spondyloarthritis in the United States: Persistence, Variables Associated With Persistence, and Dosing Variations
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: The objective of this study was to evaluate 12-month persistence of biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) treatment in US patients with axial spondyloarthritis (axSpA) using real-world data, and patient baseline characteristics associated with increased or decreased persistence probability. METHODS: Anonymized US claims from Merative MarketScan provided patient data relative to an index date (initiation of a new b/tsDMARD of interest for axSpA), from which patients were followed for 12 months or until b/tsDMARD non-persistence (≥ 90-day gap or b/tsDMARD switch) or MarketScan disenrollment. Persistence probabilities were estimated using Kaplan-Meier survival curves. Association of variables with persistence was estimated using multivariable Cox regression analyses. RESULTS: Of the 5970 adults with axSpA, 76.7% were prescribed a TNFi as their index b/tsDMARD, and 55.1% were b/tsDMARD-unexposed while 44.9% were b/tsDMARD-exposed before index b/tsDMARD. b/tsDMARD persistence probability was 67.8%, 57.7%, and 54.4% at 6, 9, and 12 months, respectively. 12-month persistence probabilities stratified by index b/tsDMARD mode of action or history of b/tsDMARD treatment ranged from 51.8% to 55.7%. Female sex and history of dactylitis were associated with decreased b/tsDMARD persistence, while history of inflammatory bowel disease, uveitis, and obesity were associated with increased persistence probability. CONCLUSIONS: Around half of patients studied were non-persistent with any given b/tsDMARD within a year of initiating therapy. Persistence was not considerably affected by index b/tsDMARD mode of action or history of b/tsDMARD treatment. Patient characteristics associated with decreased persistence probability, including female sex and dactylitis, may help clinicians recognize patients who may benefit from additional support to improve long-term treatment outcomes.
DOI: 10.1002/pds.70197
Institutions: Boston University, University of Utah, VA Salt Lake City Healthcare System, University of Utah Health Care, Oregon Health & Science University, University of California, San Francisco, University of California San Francisco Medical Center, University of Alabama at Birmingham, UAB Medicine, UCB Pharma (Belgium), University of Copenhagen, UCB Pharma (France)
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,650
Funder: UCB
OpenAlex ID: W4413770321