Treatment Outcomes: Should PsA Patients Switch Their TNFi or Change to non-TNFi?

Psoriatic arthritis (PsA) patients being treated with a tumor necrosis factor inhibitor (TNFi) may have a reduced financial burden and better treatment adherence if they switch to another TNFi as opposed to changing to a non-TNFi biologic therapy.

“To date, there have been no studies assessing the economic impact of switching from an initial TNFi to an alternative TNFi or non-TNFi biologic in PsA,” the study authors wrote.

Reporting in Rheumatology and Therapy, they compared healthcare resource use (HRU), expenditures, and time to discontinuation among PsA patients who initiated TNFi treatment and then switched to either a different TNFi or a non-TNFi. Patients were identified in the Symphony Health Solutions database (Quarter [Q]1 2010–Q2 2017) and were initially taking TNFis adalimumab, etanercept, infliximab, golimumab, or certolizumab pegol and either changed to a different one or initiated non-TNFi treatment with ustekinumab or secukinumab. Eligibility criteria included claims data activity for ≥ 12 months before (baseline) and after (study period) the switching date. Exclusion criteria included any prescription for a targeted PsA treatment before the first initial TNFi claim; any previous use of the index drug prior to the index date; > 1 switched-to drug on the index date; or a history of rheumatoid arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, or non-infectious uveitis prior to the index date.

TNFi Comes Out on Top

Final analysis included 2,107 patients switching to a different TNFi and 253 switching to a non-TNFi. In the TNFi group, most patients switched to either adalimumab (n = 957, 45.4%) or etanercept (n = 721, 34.2%), followed by infliximab (n = 177, 8.4%), certolizumab pegol (n = 130, 6.2%), and golimumab (n = 122, 5.8%); among those changing to a non-TNFi, the majority (n = 219, 86.6%) changed to ustekinumab, and the rest changed to secukinumab (n = 34, 13.4%)—no one changed to abatacept. Mean age was similar between the groups—TNFi, 50.09 years; non-TNFi, 51.35 years—and both cohorts were majority-female (60.3% vs. 54.5%, respectively).

Compared to those changing to a non-TNFi, patients switching to a new TNFi had fewer dermatologist visits (0.43, p < 0.01) but more rheumatologist visits (1.56, p < 0.01). The TNFi patients also had better financial outcomes, the researchers observed: “Patients switching to another TNFi vs. a non-TNFi incurred significantly lower total average healthcare expenditures (adjusted difference: $17,625; p < 0.01), driven by lower prescription drug (adjusted difference: $17,172; p < 0.01) and hospitalization expenditures (adjusted difference: $5772; p = 0.04).”  The TNFi group also adhered to their new treatment therapy longer than the non-TNFi cohort (median time to discontinuation: 8.31 vs. 5.68 months; log-rank p < 0.01).

The researchers concluded, “Adult patients with PsA who switched to another TNFi after discontinuation of their initial TNFi incurred lower total all-cause and PsA-related healthcare expenditures than patients who switched to a non-TNFi biologic,” adding, “These findings suggest potential overall economic savings associated with of switching to a different TNFi compared with switching to a non-TNFi biologic among TNFi-experienced patients with PsA.”