Am Health Drug Benefits. 2015 Dec;8(9):494-505.
Novel Adherence Measures for Infusible Therapeutic Agents Indicated for Rheumatoid Arthritis.
American health & drug benefits
Joseph Tkacz, Michael P Ingham, Brenna L Brady, Roxanne Meyer, Charles Ruetsch
Affiliations
Affiliations
- Mr Tkacz is Director of Analytics, Health Analytics, Columbia, MD.
- Mr Ingham is Director, HECOR, Janssen Scientific Affairs, Horsham, PA.
- Dr Brady is Project Director, Health Analytics, Columbia, MD.
- Dr Meyer is Manager, HECOR, Janssen Scientific Affairs, Horsham, PA.
- Dr Ruetsch is President and Chief Executive Officer, Health Analytics, Columbia, MD.
PMID: 26834936
PMCID: PMC4719139
Abstract
BACKGROUND: Published studies on adherence to biologic medications show that many types of calculation methods are used. However, infused biologics are not well-suited to typical measures of adherence, such as proportion of days covered.
OBJECTIVE: To construct and assess 7 novel adherence measures potentially applicable to infusible biologic agents and compare outcomes for 2 infusible biologics used for the treatment of patients with rheumatoid arthritis (RA).
METHODS: Adults (aged ≥18 years) diagnosed with RA (ie, 2 or more 714.x claims) who received ≥24 months of continuous medical and pharmacy eligibility and who started taking abatacept or infliximab therapy were selected from a large commercial insurer database of medical and pharmacy claims. The 7 new adherence measures included cumulative amount of time with a refill gap ≥20% (CG20) beyond the expected infusion interval, cumulative time off treatment, days of uninterrupted use (DoUU), observed versus expected refill ratio (OvERR), repeated observations of underuse (RoUU), variance in time between infusions, and time to discontinuation (TTD). Mean observed infusion intervals were calculated and served as a reference measure of adherence.
RESULTS: The mean maintenance intervals approximated recommended guidelines. The mean observed infusion interval for abatacept recipients was 33 days (recommended, 28 days); it was 53 days (recommended, 56 days) for patients receiving infliximab. Three measures demonstrated a significant positive relationship to the mean observed infusion interval-CG20 (r = .258), DoUU (r = .212), and TTD (r = .081; P <.05). OvERR (r = -.072) and RoUU (r = -.189; P <.05) showed significant negative correlations. Real-world comparisons showed that adherence was significantly (P <.001) greater for the infliximab group according to most measures.
CONCLUSION: New measures of adherence correlate significantly with mean maintenance intervals. Future studies should examine relationships between these adherence measures and clinically relevant end points and/or cost outcomes to determine their predictive utility. Alternative methods of reporting adherence may have greater clinical significance than traditional measures.
Keywords: abatacept; adherence measures; infliximab; infusible biologics; maintenance therapy; rheumatoid arthritis
References
- Arthritis Res Ther. 2009;11(1):R26 - PubMed
- Med Care. 2002 Sep;40(9):794-811 - PubMed
- Ann Rheum Dis. 2015 Feb;74(2):354-60 - PubMed
- Value Health. 2007 Jan-Feb;10(1):3-12 - PubMed
- Adv Ther. 2009 Oct;26(10):936-46 - PubMed
- Am Health Drug Benefits. 2015 Dec;8(9):494-505 - PubMed
- Arthritis Rheum. 2005 Dec 15;53(6):872-8 - PubMed
- Value Health. 2008 Jan-Feb;11(1):44-7 - PubMed
- Adv Ther. 2011 Aug;28(8):671-83 - PubMed
- JAMA. 2009 Mar 25;301(12):1260-72 - PubMed
- Clin Exp Rheumatol. 2012 Jul-Aug;30(4 Suppl 73):S72-84 - PubMed
- Arthritis Rheum. 2011 Mar;63(3):633-9 - PubMed
- Am J Manag Care. 2009 Jun 01;15(6):e22-33 - PubMed
- Patient Prefer Adherence. 2013 Jun 12;7:509-16 - PubMed
- Expert Rev Clin Immunol. 2012 May;8(4):337-51 - PubMed
- Arthritis Care Res (Hoboken). 2012 May;64(5):625-39 - PubMed
- Health Aff (Millwood). 2011 Jan;30(1):91-9 - PubMed
- Med Care. 2005 Jun;43(6):521-30 - PubMed
- Arthritis Rheum. 2003 Oct;48(10):2750-62 - PubMed
- Rheumatology (Oxford). 2007 Mar;46(3):529-32 - PubMed
- Int J Clin Rheumtol. 2010 Jun 1;5(3):313-326 - PubMed
- Joint Bone Spine. 2005 Jul;72(4):309-12 - PubMed
- Exp Clin Transplant. 2003 Jun;1(1):39-47 - PubMed
- Arthritis Res Ther. 2009;11 Suppl 1:S1 - PubMed
- J Manag Care Pharm. 2012 Sep;18(7):527-39 - PubMed
- Arthritis Rheum. 2008 Jun 15;59(6):762-84 - PubMed
- Adv Ther. 2005 Jul-Aug;22(4):313-56 - PubMed
- J Chronic Dis. 1987;40(5):373-83 - PubMed
- Patient Prefer Adherence. 2012;6:417-26 - PubMed
- Arthritis Rheum. 1999 Jun;42(6):1209-18 - PubMed
- Am J Med Qual. 2006 Jul-Aug;21(4):269-75 - PubMed
- Adv Ther. 2015 Apr;32(4):341-55 - PubMed
- Orthop Nurs. 2010 Jul-Aug;29(4):260-75 - PubMed
- J Manag Care Pharm. 2006 Sep;12(7):555-69 - PubMed
- Am J Med Sci. 2010 Oct;340(4):282-90 - PubMed
- Z Rheumatol. 2011 Apr;70(3):232-4, 236-8 - PubMed
- Expert Opin Biol Ther. 2010 Sep;10(9):1367-78 - PubMed
- Curr Rheumatol Rep. 2014 Nov;16(11):460 - PubMed
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