Guidelines recommend treating to targets based on quantitative endpoints for patients with rheumatoid arthritis (RA), but this can be difficult with incomplete reporting in electronic health records (EHRs).
An abstract presented at the 2017 American College of Rheumatology’s Annual Meeting examined the clinical measures available in an EHR database to determine how well rheumatologists can determine if treatment targets are being met and if therapy needs to be modified to achieve targets.
The researchers analyzed the Optum One EHR database and included data on patients who were at least 18 years old and had RA diagnoses 3-7 days apart. The index date for patients who switched from a tumor necrosis factor inhibitor to a different medication was the switch date, while the index date for patients with a biologic or targeted synthetic disease-modifying antirheumatic drug (tsDMARD) was the date of the first prescription written.
The researchers found validated measures of disease severity were reported infrequently—between 0% and 25.2%—and data reporting in the 10 largest integrated delivery networks’ EHRs varied significantly.
“With greater emphasis on a treat-to-target approach, more consistent and more complete EHR reporting is recommended to assist rheumatologists in tracking whether treatment targets for RA are being met with biologic or tsDMARD therapy appropriately,” the authors concluded.
A second poster from the meeting analyzed the cost of using sarilumab to treat patients with active, moderate-to-severe RA. The researchers used outcomes data from the MONARCH study, which evaluated sarilumab 200 mg subcutaneous + placebo every 2 weeks against adalimumab 40 mg subcutaneous + placebo every 2 weeks, and effective treatment was defined on ACR20, ACR50, and EULAR Moderate/Good (EULAR). The patients studied were either intolerant of, had an inadequate response to, or in general were considered inappropriate candidates for treatment with methotrexate (MTX).
The 24-week drug cost for sarilumab was $18,000, compared with $26,647 for adalimumab, and based on those costs, the researchers found the costs per responder for each outcome were:
- ACR20: $25,105 for sarilumab and $45,629 for adalimumab
- ACR50: $39,387 for sarilumab and $89,722 for adalimumab
- EULAR: $21,378 for sarilumab and $37,584 for adalimumab
“Given the higher levels of responses on ACR20, ACR50, and [EULAR], coupled with the lower 24-week drug costs, sarilumab across all analyses was the favorable treatment in terms of cost per responder,” the authors concluded.
Finally, a third abstract presented data on duration of response of sarilumab + MTX in patients with active, moderate-to-severe arthritis. The researchers used phase 3 data of the MOBILITY study to determine differences in mean duration of response. Only patients who achieved a response at any time during the study were included in the analyses.
The study had 3 arms: patients receiving either sarilumab 150 or 200 mg every 2 weeks + MTX, and patients receiving placebo every 2 weeks + MTX.
The study used 5 different definitions for duration of response:
- First response to loss of response
- Longest response
- Responder Weeks
- Responder Weeks percent
- Sustained response
“Regardless of the definition used, patients treated with either dose of sarilumab + MTX experienced longer duration of response vs those treated with placebo + MTX,” the authors concluded.