Treatment sequences of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis: A nationwide population-based study in France.

OBJECTIVES

The study aimed to describe nationwide treatment sequences in French patients with rheumatoid arthritis (RA) initiating a first biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD).

METHODS

This analysis is based on the French National Health Claims Database (SNDS), covering over 67 million people. Patients with RA (ICD-10 codes M05, M060, M068 or M069) and ≥2 b/tsDMARD dispensings from January 1, 2014 to December 31, 2019 were included, and followed until December 31, 2020 or death. Differences in patients characteristics at each b/tsDMARD initiation were tested with Mann Whitney U tests and χ2 tests.

RESULTS

Overall, 26 478 patients were identified (mean (SD) age 57.0 years (±14.4)) including 70.9% females. The most frequent first-line of b/tsDMARD were TNF inhibitors (TNFi) (62.6%), followed by abatacept (CTLA4-Ig) (12.0%), rituximab (11.0%), IL-6R inhibitors (IL-6Ri) (10.0%), and JAK inhibitors (JAKi) (3.9%). The mean (SD) follow-up duration was 3.8 years (±1.7 years,), for a total of 100 332 person-years. Throughout the study period, 12,662 patients (47.8%) maintained their first b/tsDMARD, while 7531 (28.4%) switched to a second b/tsDMARD, and 3046 (11.1%) to a third b/tsDMARD, after a mean duration of 54.1 (±34.0), 31.9 (±27.8) and 25.9 (±22.2) months, respectively. In terms of mode of action associated profiles, the main discrepancies were age, higher in CD20i and LT modulator patients, and comorbidities, more prevalent in CD20i treated patients.

CONCLUSION

In this nation-wide analysis of 26 478 patients, TNFi was the most frequently dispensed first-line b/tsDMARD, with LT modulators and IL-6i preferred in second-line therapy.