Variation in the use of biologics in the management of rheumatoid arthritis across the UK

Abstract

Objectives:

Treatment options for rheumatoid arthritis (RA) include conventional synthetic disease-modifying antirheumatic drugs (sDMARDs) and newer biologic DMARDs (biologics). This study describes treatment patterns, adherence to guidance and outcomes at hospital/regional level in the UK.

Methods:

This was a retrospective cohort study of RA patients selected from six health regions and from four hospitals in each region, including at least one major teaching hospital and two to three district/general hospitals. Treatment with sDMARDs/biologics was examined between November 2009 and June 2010 in comparison with National Institute for Health and Clinical Excellence (NICE) guidance and in relation to disease activity.

Results:

NICE guidance focuses on initiation of therapy and recommends combination sDMARD/biologic therapy. Analysis of 588 patient records indicates that overall 23% of patients were receiving biologic monotherapy. NICE guidance recommends initiation of biologics in patients with active RA (DAS28 >5.1): average DAS28 score on initiation of biologic therapy was above six in all regions. Range of DAS28 improvement post-biologic therapy was similar across all regions. DAS28 scores were well recorded within patient records at baseline and 6 months but not at other time points.

Conclusions:

Our data highlight that nearly a quarter of patients receiving biologic treatments are not receiving concomitant sDMARD therapy and that DAS28 is poorly documented in patient medical records other than when initiating biologics and at the 6-month review. Limitations of this study include the limited sample size, the retrospective rather than prospective nature of the audit and the use of medical records only rather than other records such as nursing and pharmacy data. Nevertheless, the reasons for our findings merit further investigation to ensure that optimum treatment regimes and long term outcomes are being achieved for patients.

Key words::

• Biologics
• Rheumatoid arthritis
• Treatment patterns
• Variation

Transparency

Declaration of funding

This work was supported by Roche-Chugai who funded the study and data analysis. Funding sources had no influence on the study design, interpretation of results, or decision to submit the article. E.C., S.M. and K.R. made primary contributions to study design, data collection, data analysis, interpretation of results, and writing the manuscript; P.T. made primary contributions to interpretation of results and writing the manuscript; I.S. made primary contributions to writing the manuscript. All authors contributed to the interpretation of results and critical revision of the manuscript and approved the final manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Declaration of financial/other relationships

E.C. has declared: sponsorship from Chugai Pharma, Jazz Pharmaceuticals, Roche, MSD, Pfizer, Schering Plough and UCB; grant/research funding from Abbott Laboratories, Boehringer Ingelheim, Chelsea Therapeutics, Chugai Pharma, GSK, Jazz Pharmaceuticals, MSD, Novartis, Pierre Fabre Medicament, Roche and UCB; consultant/advisor for Abbott Laboratories, Allergan, AstraZeneca, Boehringer Ingelheim, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceutical, GSK, Jazz Pharmaceuticals, MedImmune, Merrimack Pharmaceutical, MSD, Novartis, Pfizer, Pierre Fabre Medicament, Roche, Schering Plough, Synovate and UCB; speakers bureau for Abbott Laboratories, Boehringer Ingelheim, Chugai Pharma, Eli Lilly, Jazz Pharmaceuticals, MSD, Novartis, Pfizer, Pierre Fabre Medicament, Roche, Schering Plough, Synovate and UCB. P.T. has declared: grant/research funding from GSK, Merck, UCB, AstraZeneca and Celgene; consultant/advisor for Pfizer, Merck, UCB, Abbott, Novartis, Roche, Lilly, Novo Nordisk, AstraZeneca, Takeda, BMS, Celgene and GSK. S.M. provided data analysis and graphical representation funded by Roche Products Ltd. K.R. is an employee of Roche Products Ltd. I.S. provided medical writing support funded by Roche Products Ltd.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors thank Claire Housden and Kirsty Roberts (Roche Products Ltd) for procuring project funding and Ify Sargeant (Ismedica Ltd) for medical writing support, funded by Roche Products Ltd.