J Rheum Dis.  2023 Jan;30(1):26-35. 10.4078/jrd.22.0024.

Treatment Sequence After Initiating Biologic Therapy for Patients With Rheumatoid Arthritis in Korea: A Nationwide Retrospective Cohort Study

• Kim MJ
• Park JW
• Lee SK
• Jang Y
• Kim S
• Stoelzel M
• Chua JL
• Shin K

• KMID: 2537492
• DOI: http://doi.org/10.4078/jrd.22.0024

Abstract

Objective
To evaluate treatment patterns and healthcare resource utilization (HCRU) after initiating biologic disease-modifying antirheumatic drugs (bDMARDs) in Korean patients with rheumatoid arthritis (RA).
Methods
Patients newly diagnosed with RA in 2014 were identified and followed up on using the Korean National Health Insurance Database until 2018. The initial line of therapy (LOT) or LOT1 included patients treated with conventional DMARDs (cDMARD). Patients who started a bDMARD were assigned to LOT2 bDMARD. Those who moved from a bDMARD to a Janus kinase inhibitor were assigned to LOT3. Analyzed outcomes were treatment patterns and HCRU in LOT2 bDMARD.
Results
The most prescribed initial bDMARD was a tumor necrosis factor inhibitor. Seventy-five percent of patients had changes in treatment after starting a bDMARD, such as addition/removal or switch of a DMARD, and transition to LOT3. For the first and second changes in LOT2 bDMARD, adding a cDMARD to a bDMARD was more common than switching to another bDMARD (7.98% vs. 2.93% for the first change, and 17.10% vs. 6.51% for the second change). Tocilizumab was the most common bDMARD that was switched to. Forty-eight percent of patients had at least one hospitalization after initiating bDMARDs. Of these patients, 64.3% were admitted due to RA-related reasons.
Conclusion
This real-world study provides information on treatment characteristics of RA patients in Korea after starting a bDMARD. In contrary to guidelines, cDMARD addition was more often than bDMARD switches in daily clinical practice.

Keyword

Rheumatoid arthritis; DMARD; Biologics; Health resources

Figure

• 

  Fig. 1 Flow chart of patient selection. January 1, 2014 to December 31, 2014 was designated as the index period. The index date was defined as the date of first cDMARD prescription. The baseline period was defined as 12 months before the index date. The study period was the period from index date to December 31, 2018 during which patient data were collected. bDMARD: biologic disease-modifying antirheumatic drug, cDMARD: conventional disease-modifying antirheumatic drug, ICD: International Classification of Diseases 10th revision, JAKi: Janus kinase inhibitor, RA: rheumatoid arthritis, LOT: line of treatment.

• 

  Fig. 2 Common initial and last treatment regimens in LOT2 bDMARD (n=614). LOT: line of therapy, bDMARD: biologic disease-modifying antirheumatic drug, MTX: methotrexate, LEF: leflunomide, HCQ: hydroxychloroquine.

• 

  Fig. 3 Kaplan–Meier plots showing (A) time point of discontinuing all DMARDs in LOT2 bDMARD and (B) the entry point to LOT3 from LOT2 bDMARD. The first date of the LOT2 period is depicted as 0 on the X-axis. DMARDs: biologic disease-modifying antirheumatic drugs, LOT: line of therapy, bDMARD: biologic disease-modifying antirheumatic drug.

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