Long-term Comparative Adherence and Switch Rates in Patients Receiving Advanced Therapies for Rheumatoid Arthritis After Use of One TNF Inhibitor.

INTRODUCTION

Patients with rheumatoid arthritis (RA) often fail to achieve treatment targets with first-line treatment because of poor efficacy or tolerability. However, comparative long-term adherence and switching data among patients initiating a second-line therapy after a first-line tumor necrosis factor inhibitor (TNFi) remain limited.

METHODS

Retrospective data were from the Merative MarketScan® claims database, August 2018-October 2024. Eligible patients were aged ≥ 18 years; diagnosed with RA; initiated upadacitinib (UPA), tofacitinib (TOF), adalimumab (ADA), etanercept (ETA), abatacept (ABA), or tocilizumab (TOC); and had discontinued a first-line TNFi within 12 months prior to index. Treatment adherence and switching outcomes were reported at 1- and 3-year follow-up.

RESULTS

Overall, 3782 and 1182 patients were included for the 1- and 3-year analyses, respectively. The proportion of patients with adherence ≥ 80% was highest with UPA at 1-year (49.5%) and 3-year follow-up (35.7%) versus other treatments. Compared with UPA through 3 years, odds of being adherent were significantly lower for TOF (adjusted odds ratio [95% confidence interval]: 0.45 [0.29-0.71]), ADA (0.50 [0.33-0.75]), ETA (0.37 [0.24-0.58]), ABA (0.43 [0.26-0.73]), and TOC (0.46 [0.22-0.99]; p < 0.05). Switch rates were lowest for UPA versus other treatments at 1 year (28.6%) and remained lowest through 3 years (47.6%), while rates for all other treatments increased to approximately 60%. Through 3 years, patients were also significantly (p < 0.05) more likely to switch treatment when receiving TOF (adjusted hazard ratios [95% confidence interval]: 1.40 [1.07-1.84]), ADA (1.44 [1.12-1.86]), ETA (1.57 [1.21-2.03]), ABA (1.56 [1.16-2.10]), and TOC (1.54 [1.03-2.32]) compared with UPA. Median 3-year time to switch was not reached for UPA and was 528-660 days for all other treatments.

CONCLUSION

Among patients with RA who discontinued a first-line TNFi, second-line UPA was associated with significantly greater long-term adherence and lower switching rates than other advanced therapies.