Association among anti-citrullinated protein antibody status, erosive disease and healthcare resource utilization in patients with rheumatoid arthritis

Abstract

Objective: To characterize the rate of healthcare resource utilization (HCRU) between anti-cyclic citrullinated peptide (CCP; a surrogate for anti-citrullinated protein antibodies [ACPAs]) positive (+) patients with rheumatoid arthritis (RA), either with or without erosions, who initiated biologic disease-modifying antirheumatic drug (bDMARD) treatment.

Methods: Data from the Corrona RA registry, a prospective registry of adult patients with RA from 177 sites across 42 states in the US, were analyzed. Annual rates of HCRU (measured based on rates of all-cause hospitalization, joint surgery, imaging procedures and use of assistive devices) were estimated in anti-CCP + patients with and without erosions following bDMARD initiation using a Poisson regression model.

Results: Among the 3333 patients with known anti-CCP and erosion status and 12-month post-bDMARD follow-up information in the Corrona registry, 2047 were anti-CCP + and included in this analysis; 868 with and 1179 without erosions. Baseline characteristics were generally well balanced between patients with and without erosions; however, those with erosions had a longer mean RA duration and a higher prior DMARD use. Over 12 months, among anti-CCP + patients, those with erosions had significantly higher rates of all HCRU, except joint surgery, than those without erosions. Age-adjusted risk ratios (95% confidence interval) were as follows: all-cause hospitalization, 1.47 (1.14, 1.90); all-cause imaging, 1.25 (1.03, 1.53); and assistive device use 1.12 (1.00, 1.25). The rate of joint surgery visits was also numerically higher in patients with versus without erosion.

Conclusions: ACPA seropositivity with erosive disease was associated with higher rates of HCRU compared with seropositivity without erosions. These findings suggest that providers may want to manage anti-CCP + patients aggressively to achieve better disease control to prevent the development of erosions and the associated increase in HCRU.

Keywords:

• Rheumatoid arthritis
• health resources
• biologic therapy
• anti-citrullinated protein antibodies

Transparency

Declaration of funding

This study is sponsored by Corrona, LLC and funded by Bristol-Myers Squibb. The design and study conduct were a collaborative effort between Corrona and Bristol-Myers Squibb, and financial support for the study was provided by Bristol-Myers Squibb.

Declaration of financial/other relationships

L.R.H. is an employee of Corrona, LLC, has stock options in Corrona, LLC, has received grant funding from Pfizer and is a consultant to AbbVie, Bristol-Myers Squibb and Roche. S.E.C. and E.A. have stock options/bond holdings in, and are employees of, Bristol-Myers Squibb. Y.S., S.R. and L.G. are employees of Corrona, LLC. J.M.K. has stock options/bond holdings in, and is an employee of, Corrona, LLC; is a consultant for AbbVie, Amgen, Bristol-Myers Squibb, Genentech, Lilly, Pfizer Inc., Regeneron and Sanofi; and has received research grants from AbbVie, Genentech, Lilly, Novartis and Pfizer. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors made a substantial contribution to the conception and design, execution, or analysis and interpretation of data for this study. All authors were involved in writing and critically drafting the article or revising it critically for important intellectual content. All authors approved the final version to be submitted for publication and agree to be accountable for all aspects of the work. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgements

The authors would like to thank all of the patients and providers who have participated in the Corrona RA registry. This study was sponsored by Corrona, LLC. Corrona has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Crescendo, Eli Lilly and Company, Genentech, Gilead, GlaxoSmithKline, Janssen, Merck, Momenta Pharmaceuticals, Novartis, Pfizer Inc., Regeneron, Roche, Sun, UCB and Valeant. Professional medical writing and editorial assistance was provided by Lola Parfitt, MRes, at Caudex and was funded by Bristol-Myers Squibb.

Data availability statement

Bristol-Myers Squibb policy on data sharing may be found at https://www.bms.com/researchers-and-partners/independent-research/data-sharing-request-process.html.

The Corrona dataset is based on a large US multicenter study adhering to a number of institutional review boards, with complex logistics. Patients did not provide consent to raw data sharing during the data collection for this purpose, and the Corrona data sharing policies do not permit raw data sharing for this purpose. An aggregated limited dataset from the current analyses is available to qualified investigators with an approved protocol. Data requests may be sent to Corrona, represented by Dr. Jeff Greenberg, e-mail [email protected].