title: Clinical Outcomes and Biologic Costs of Switching Between Tumor Necrosis Factor Inhibitors in US Veterans with Rheumatoid Arthritis.
abstract: The purpose of this study was to evaluate clinical outcomes and drug/administration costs of treatment with tumor necrosis factor inhibitor (TNFi) agents in US veterans with rheumatoid arthritis (RA) initiating TNFi therapy. The analysis compared patients initiating and continuing a single TNFi with patients who subsequently switched to a different TNFi.
  
  
  
  Data from patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry who initiated treatment with adalimumab, etanercept, or infliximab from 2003 to 2010 were analyzed. Outcomes included duration of therapy, Disease Activity Score based on 28 joints (DAS28), and direct drug and drug administration costs.
  
  
  
  Of 563 eligible patients, 262 initiated a single TNFi therapy, 142 restarted their initial TNFi after a ≥90-day gap in treatment (interrupted therapy), and 159 switched to a different TNFi. Patients who switched had higher mean DAS28 before starting TNFi therapy than patients with single or interrupted therapy: 5.3 vs 4.5 or 4.6, respectively. Mean duration of the first course was 34.3 months for single therapy, 18.3 months for interrupted therapy, and 17.7 months for switched therapy. Mean post-treatment DAS28 was highest for patients who switched TNFi. Mean annualized costs for first course were $13,800 for single therapy, $13,200 for interrupted therapy, and $14,200 for switched therapy; mean annualized costs for second course were $12,800 for interrupted therapy and $15,100 for switched therapy.
  
  
  
  Patients who switched TNFi had higher pre-treatment DAS28 and higher overall costs than patients who received the same TNFi as either single or interrupted therapy.
  
  
  
  This research was funded by Immunex Corp., a fully owned subsidiary of Amgen Inc., and by VA HSR&D Grant SHP 08-172.
authors.affiliation: Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA. Grant.Cannon@va.gov.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Cannon
authors.affiliation: Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: DuVall
authors.affiliation: Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Candace L
authors.initials: CL
authors.lastname: Haroldsen
authors.affiliation: Denver VA and University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Liron
authors.initials: L
authors.lastname: Caplan
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.|National Data Bank for Rheumatic Diseases, Wichita, KS, USA.
authors.forename: Kaleb
authors.initials: K
authors.lastname: Michaud
authors.affiliation: VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.affiliation: Dallas VA and University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Reimold
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Collier
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Joseph
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Harrison
authors.affiliation: Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Sauer
mesh_terms: D000068879:Adalimumab / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D057915:Drug Substitution; D000068800:Etanercept / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000191:economics*; D014481:United States; D014728:Veterans
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Adalimumab; Biologics; Cost; Etanercept; Infliximab; Rheumatoid arthritis; Rheumatology; Switching; Tumor necrosis factor; Veterans affairs