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Identifying inadequate response among patients with ankylosing spondylitis and psoriatic arthritis prescribed advanced therapy in a real-world, commercially insured adult population in the USA

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Abstract

Objective

This study aimed to assess treatment patterns and frequency of inadequate response associated with advanced therapy initiation among patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in the USA.

Methods

Adult patients with AS or PsA who initiated advanced therapy were identified from the HealthCore Integrated Research Database®. Inadequate response to advanced therapies (tumour necrosis factor inhibitors [TNFi] and non-TNFi biologics) was identified using a claims-based algorithm. Factors influencing inadequate response were assessed using multivariable logistic regression.

Results

In total, 646 patients with AS, and 1433 patients with PsA were evaluated. Among patients with AS (mean age, 43 years; male, 58%), 93% patients initiated TNFi, and 69% of patients had inadequate response. In patients with PsA (mean age, 49 years; male, 47%), 67% initiated TNFi, and 77% had inadequate response. Low adherence was the main predictor of inadequate response in patients with AS (56%) and PsA (63%). Inadequate responders were more likely to be female (odds ratio [OR] 2.05 for AS and 1.37 for PsA). Prior exposure to TNFi was associated with 3.89- and 2.14-fold greater odds of inadequate response in both AS and PsA patients, respectively, while patients using methotrexate were less likely to have inadequate response (OR 0.48 for AS and 0.72 for PsA; all p < 0.05).

Conclusions

Over 69% of patients with AS and 77% of patients with PsA had inadequate response to their index advanced therapy during 1 year after initiation. Health plan claims data appear useful to classify inadequate responders in AS and PsA.

Key Points

• Estimating inadequate response to advanced therapies and identifying factors associated with this outcome using claims data could improve treatment outcomes in AS and PsA.

• In a sample of commercially insured US patients, over 69% of patients with AS and 77% of patients with PsA had inadequate response to their index advanced therapy during 1 year after initiation. Patient characteristics such as sex and prior therapy use were predictive of inadequate response to advanced therapies.

• Health plan claims data appear useful to classify inadequate responders in AS and PsA and identify factors associated with this outcome.

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Data availability

The data that support the findings of this study are available from HealthCore, but restrictions apply to the availability of these data to external sources, and therefore they are not publicly available. Data may be made available through the corresponding author upon reasonable request and with permission of HealthCore.

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Acknowledgements

Medical writing and editorial support were provided by Santanu Bhadra, PhD, and Priyanka Bannikoppa, PhD, of Eli Lilly Services India Private Limited, Bengaluru, India.

Funding

This study was funded by Eli Lilly and Company.

Author information

Authors and Affiliations

  1. Eli Lilly and Company, Indianapolis, IN, USA

    Theresa Hunter, Julie Birt, Mingyang Shan, Jianmin Wu, Kirstin Griffing & Jeffrey Lisse

  2. HealthCore, Inc., Wilmington, DE, USA

    Michael Grabner & Chia-Chen Teng

  3. Anthem, Inc., Indianapolis, IN, USA

    Keith Isenberg

  4. University of Alabama at Birmingham, Birmingham, AL, USA

    Jeffrey R. Curtis

Authors
  1. Theresa Hunter
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  2. Michael Grabner
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  3. Julie Birt
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  4. Keith Isenberg
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  5. Mingyang Shan
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  6. Chia-Chen Teng
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  7. Jianmin Wu
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  8. Kirstin Griffing
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  9. Jeffrey Lisse
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  10. Jeffrey R. Curtis
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Contributions

TH, MG, JB, KI, MS, CT, JW, KG, JS, and JRC made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. All the authors were involved in drafting the manuscript or revising it critically for important intellectual content and gave final approval of the version to be published.

Corresponding author

Correspondence to Theresa Hunter.

Ethics declarations

Ethics approval and consent to participate

Researchers accessed data in the format of a limited dataset for which data use agreements were in place with the covered entities in compliance with the Health Insurance Portability and Accountability (HIPAA) Privacy Rule. All data analyses and results occurred in a de-identified and aggregated format. During the course of secondary use of data in observational research, information pertaining to adverse events was not discovered because the study did not involve identifiable patient data associated with a Lilly product.

Consent for publication

Not applicable.

Disclosures

JRC reported financial relationships with AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB. KI is an Anthem employee and shareholder. MG and CCT are employees of HealthCore, Inc., which was under contract with Eli Lilly and Company for conducting the study on which this manuscript is based. MG is an Anthem shareholder. TH, JB, KG, MS, JW and JL are employees and shareholders of Eli Lilly and Company.

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Hunter, T., Grabner, M., Birt, J. et al. Identifying inadequate response among patients with ankylosing spondylitis and psoriatic arthritis prescribed advanced therapy in a real-world, commercially insured adult population in the USA. Clin Rheumatol 41, 2863–2874 (2022). https://doi.org/10.1007/s10067-022-06230-y

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  • DOI: https://doi.org/10.1007/s10067-022-06230-y

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