Abstract
Objective
This study aimed to assess the level of nonpersistence (NP) and nonadherence (NA) to methotrexate (MTX) therapy in German patients with rheumatoid arthritis (RA).
Materials and methods
Based on German claims data, RA patients who received a MTX therapy (subgroup: treatment-naive patients) were analyzed. NP was defined as treatment gap >12 weeks. Regarding NA, it is the overall medication possession ratio (MPR) during an observational period of 12 or 24 months after therapy, and the MPR is calculated only for the periods of therapy continuation; NA was defined as MPR <80%.
Results
A total of 7,146 RA patients who received at least one MTX prescription (subgroup: 1,211 treatment-naive patients) could be observed (mean age: 64.4 years, 73.6% female). Percentage of NP patients among MTX-naive patients after 6, 12 and 18 months was 16.7%, 34.0% and 36.7%, respectively. After MTX therapy discontinuation, 39.9% had restarted their MTX therapy, 13.8% had received another non-MTX synthetic disease-modifying antirheumatic drug (sDMARD), 8.1% had biological DMARD (bDMARD) and 49.2% had not received any DMARD prescription at all. Overall, 12- and 24-month MPRs for MTX therapy were 83.0% and 76.5% with a percentage of NA patients of 25.8% and 33.8%, respectively. During periods of general treatment continuation, the percentage of patients with an MPR <80% was 6.5%.
Conclusion
NP to MTX treatment seems to be common in one-fourth of German patients with RA. An additional number of patients, at least 6.5%, are also affected by NA. A considerable percentage of RA patients who discontinued MTX therapy do not receive any follow-up DMARD therapy.
Supplementary material
Figure S1 Distribution of MPR among RA patients who received MTX therapy.
Notes: The figure shows the distribution of patient-specific MPRs in the sample of RA patients who received MTX therapy. MPR was calculated during periods of therapy continuation only. So, our analysis was carried out from the first observed MTX prescription until the last observed MTX prescription. In case an MTX treatment gap was observed (>12 weeks), observation ended with the date of the last prescription before that observed gap.
Abbreviations: MPR, medication possession ratio; RA, rheumatoid arthritis; MTX, methotrexate.
Acknowledgments
The authors would like to thank Dirk Ahilger, Michael Schoettler and Antje Groth for their valuable support during the manuscript preparation. This work was financially supported by Roche Pharma AG and Chugai Pharma Europe Ltd. German Branch. In view of German data protection law (SGB X), the authors are not allowed to distribute the analyzed dataset. Individuals interested in the dataset are invited to send an application to the dataset owner (AOK PLUS; Dr Ulf Maywald, [email protected]).
Author contributions
Specifically, the main tasks the authors engaged in were TW, project lead, contributed to writing all parts of the article. SM contributed to statistical analysis and validation of database. UM/AF contributed to statistical analysis and interpretation of results in discussion section. J-PF, HH and KK contributed to conception/design of the study and interpretation of results in discussion section. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.
Disclosure
TW has received honoraria from several pharmaceutical/consultancy companies (Novo Nordisk, Abbvie, Merck, GSK, BMS, LEO Pharma, Astra Zeneca, Bayer, Boehringer Ingelheim, Pharmerit). SM participated in this study as a staff member of IPAM; IPAM work in this study was sponsored by Roche Pharma AG and Chugai Pharma Europe Ltd, Germany. AF conducted consultancies for Bayer Pharma AG in 2016 and is employed by AOK PLUS. UM does not have any conflicts of interest except those potentially related to his employer, AOK PLUS. KK has received honoraria as a member of advisory boards and/or speakers bureau from: Abbvie, BMS, Medac, MSD, Pfizer, Roche and UCB. J-PF and HH are employed by Roche Pharma AG and Chugai Pharma Europe Ltd, German branch. The authors report no other conflicts of interest in this work.