title: Primary Nonadherence, Associated Clinical Outcomes, and Health Care Resource Use Among Patients with Rheumatoid Arthritis Prescribed Treatment with Injectable Biologic Disease-Modifying Antirheumatic Drugs.
abstract: BACKGROUND
  Adherence to biologic disease-modifying antirheumatic drugs (bDMARDs) among patients with rheumatoid arthritis (RA) is often suboptimal in routine clinical practice. Low or nonadherence can reduce the effectiveness of bDMARD therapies.
  
  
  OBJECTIVE
  To evaluate filling of newly prescribed initial bDMARDs for the treatment of RA and evaluate potential for characterizing treatment decisions and patient outcomes.
  
  
  METHODS
  In this retrospective cohort analysis, patients aged ≥ 18 years with an RA diagnosis (ICD-9-CM code 714.xx) were selected from a de-identified database of clinical information from the Electronic Health Record (EHR; Humedica) database linked to health care claims (Optum) from commercial and Medicare Advantage health plans (2007-2013). The first biologic prescription date in EHR was the index date. Patients were categorized as filling the prescription within 30 days (early fillers), 31-180 days (late fillers), or not at all within 180 days (nonfillers) of index date.
  
  
  RESULTS
  Of 373 patients meeting inclusion criteria, 170 (45.6%), 59 (15.8%), and 144 (38.6%) were categorized as early fillers, late fillers, and nonfillers, respectively. Most prescriptions were written or ordered for tumor necrosis factor inhibitors (88.7%). Compared with late and nonfillers, early fillers were younger and more likely to be female, with higher pain scores (among those reporting pain scores) and RA severity scores pre-index, and filled more prescriptions for any reason pre-index. More nonfillers (66.0%) were Medicare patients than early (17.7%) and late (35.6%) fillers. During days 0-30 post-index, conventional synthetic DMARD use was greatest for early fillers (45.9%) and lowest among nonfillers (24.3%); however, during days 31-180 post-index, the proportion was highest for late fillers (61.0%) and lowest for nonfillers (35.4%). Of early fillers, 12.9% did not fill/receive a bDMARD after 30 days. Only 23 patients had pre/post-index pain scores, and 47 patients had a rationale for stopping or not filling a bDMARD. In patients with pharmacy and medical coverage for 180 days post-index, early fillers had greater RA-related pharmacy and medical resource use and costs than late and nonfillers combined.
  
  
  CONCLUSIONS
  These findings confirm a high rate of primary nonadherence to bDMARDs among patients with RA.
authors.affiliation: 1 Senior Director, Real World Data and Analytics, Worldwide Policy, Pfizer, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Harnett
authors.affiliation: 2 Director, Worldwide Policy, Pfizer, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiederkehr
authors.affiliation: 3 Senior Director, Outcomes and Evidence, Statistics, Pfizer, Groton, Connecticut.
authors.forename: Robert
authors.initials: R
authors.lastname: Gerber
authors.affiliation: 4 Senior Director, Statistics, Pfizer, Groton, Connecticut.
authors.forename: David
authors.initials: D
authors.lastname: Gruben
authors.affiliation: 5 Senior Director, North America Medical Affairs, Pfizer, Collegeville, Pennsylvania.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bourret
authors.affiliation: 5 Senior Director, North America Medical Affairs, Pfizer, Collegeville, Pennsylvania.
authors.forename: Andrew
authors.initials: A
authors.lastname: Koenig
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D003695:Delivery of Health Care; D057286:Electronic Health Records; D005260:Female; D006295:Health Resources; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D006278:Medicare; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D055553:Prescription Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D055553:Prescription Drugs