SAN FRANCISCO – Stopping a tumor necrosis factor inhibitor for nonmedical reasons is associated with significantly worse clinical outcomes and increased health care resource use, according to a review of 166 rheumatoid arthritis patients from the Physicians Consulting Network.
That’s probably not a surprise; the main value of the findings is that they provide ammunition to push back against insurance decisions that lead to stopping or switching tumor necrosis factor inhibitors (TNFi) that are helping patients.
After being stable on their TNFi for at least 6 months, 25 patients in the study were forced to stop their medication for a range of nonmedical economic reasons such as increased copays, change of insurance, or loss of job health insurance. Another 58 switched to a new TNFi for similar reasons. Those 83 patients were matched to 83 others who were also stable on their TNFi for at least 6 months but continued the therapy. Data came from chart reviews by rheumatologists, and all the patients were under the care of physicians participating in the Physicians Consulting Network, which provides feedback to GfK, a market research firm.
Over the next year, 48% of switchers/discontinuers were deemed to have well controlled RA by their rheumatologists, versus 84% of continuers. Switchers and discontinuers were almost 4 times as likely to flare, and more than 10 times as likely to have severe RA at the end of the year.
Switchers/discontinuers also had more inpatient days and emergency department and urgent care visits. Switchers and discontinuers had more than six times greater odds of visiting emergency departments and urgent care clinics at least once, compared with continuers. The differences were statistically significant. In short, payers may have saved on the front end, but probably lost on the back end.
Dr. Douglas Wolf
“These real world data demonstrate that patients are significantly affected by switching or discontinuing their stable and effective [TNFi] therapy for rheumatoid arthritis. I don’t think there is any patient who asks to have their [TNFi] switched when they are doing well, and it would be uncommon for a rheumatologist to switch or discontinue [a TNFi] when patients are doing well. These are insurance-driven things that are impacting negatively on patient care, and this should stop. The [American College of Rheumatology] and other groups need to work together to get insurance companies to stop intervening in this way,” said investigator Dr. Douglas Wolf, medical director at Atlanta Gastroenterology Associates.
Similar problems have been reported when TNFi drugs are switched or stopped in Crohn’s disease, psoriasis, and other immunologic conditions, he said at the annual meeting of the American College of Rheumatology.
Switchers and discontinuers were more likely than were continuers to be Hispanic (27.7% vs. 15.7%; P = .041), but otherwise there were no significant differences between cohorts in baseline sociodemographic and disease characteristics, comorbidities, medication use, or resource utilization.
The investigators plan to continue the project to see if TNFi switchers fair better than discontinuers.
Dr. Wolf and other investigators disclosed relationships with AbbVie, including some who received payments from the company to participate in the research. Three authors are employees of AbbVie, maker of adalimumab (Humira).