A total of 449 physicians participated in the study, of whom 35% were rheumatologists, 25% neurologists, 13% internists, 9% dermatologists, 6% nephrologists, 6% pulmonologists, 5% primary care physicians, and 1% cardiologists. Data were obtained for 217 patients with RA, 190 patients with PsA, 254 patients with DM/PM, and 95 patients with SLE. Table 1 presents the demographic and clinical characteristics of the study patients with rheumatologic conditions who were receiving RCI. Mean age (standard deviation [SD]) in years was 51.69 (11.94) for the RA group, 51.96 (12.32) for the PsA group, 50.26 (12.83) for the DM/PM group, and 48.46 (10.95) for the SLE group. The groups ranged from 52% to 79% female, with the SLE group having a significantly higher proportion of females. In the RA, PsA, and DM/PM groups, approximately one-half to two-thirds of patients were Caucasian/non-Hispanic. As expected, the SLE group had a significantly higher proportion of African Americans (48%) than did the other groups. The most common comorbidities were hypertension, hyperlipidemia, gastrointestinal disorders, diabetes, and mood disorders. Across groups, more than one-third of patients had a diagnosis of hypertension and more than one-fifth had a diagnosis of hyperlipidemia. Between 22% and 36% of patients had no comorbidities.
RCI Treatment Patterns and Barriers to Access
In the four groups combined, a mean of 3.3 medications had been used before initiation of RCI therapy (3.6, 3.3, 2.9, and 3.6 medications in the RA, PsA, DM/PM, and SLE groups, respectively). Most RCI regimens (75%–94%) were the first-time use of RCI for the patient (Table 2). In all groups combined, 17% of patients received RCI as a bridge to new therapy (15%, 19%, 21%, and 5% of the RA, PsA, DM/PM, and SLE groups, respectively).
Among those medical records with information about medication access, about one-fourth (24%) of patients experienced one or more obstacles to obtaining RCI (23% of RA patients, 29% of PsA patients, 26% of DM/PM patients, and 14% of SLE patients). Among this subset of patients, the most common obstacles were the need for prior authorization (60% of patients) and high out-of-pocket costs (53% of patients). Lack of insurance, inadequate insurance, and formulary-related obstacles were other common barriers (Table 3).
Medical Resource Use
Mean medical resource use in the 3 months before and after RCI therapy is shown in Table 4. After RCI therapy, the mean number of hospital admissions and hospital days was lower in all groups and the mean number of outpatient visits was lower in the RA, PsA, and DM/PM groups. The RA and SLE groups experienced the largest percent decreases in hospital admissions (71% and 82%, respectively; both P < 0.05) and number of hospital days (83% and 91%, respectively; both P < 0.05) (Fig. 1). The DM/PM and PsA groups experienced the largest decreases in number of outpatient visits (26% and 23%, respectively, both P < 0.05). Although the SLE group experienced a 7% decrease in the number of outpatient visits after RCI therapy, this difference was not statistically significant (P = 0.323).