Persistence Among Biologic/JAKi-Naive Medicare Beneficiaries with RA Initiating Synthetic DMARDs

INTRODUCTION: Persistence to therapy to treat rheumatoid arthritis (RA) is an indirect measure of tolerability and effectiveness in the real-world setting. Previous clinical trials suggested that seropositive patients with RA may particularly benefit from abatacept. The risk of non-persistence after initiating abatacept, tumor necrosis factor inhibitors (TNFi), and Janus kinase inhibitors (JAKi) as first-line biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) was examined. METHODS: We utilized the 100% Medicare Fee-For-Service sample linked claims with Prognos laboratory data from 2012 to 2019. Newly-initiating, anti-cyclic citrullinated peptide (anti-CCP)-positive and rheumatoid factor-(RF) positive patients were identified. Index date was initiation of abatacept, TNFi, or JAKi as first-line b/tsDMARD treatment. Persistence (measured at 12 months post-index) was defined as the absence of a treatment gap ≥ 60 days, > 90 days off-treatment, or switch in therapy. Cox regression was used to investigate risk of non-persistence between the groups. RESULTS: Of 3105 patients identified, 487 received abatacept (16%), 2330 TNFi (75%), and 288 JAKi (9%). Abatacept, TNFi, and JAKi twelve-month persistence was 48%, 33%, and 39%, respectively. Beneficiaries initiating with abatacept were more likely to be persistent than those initiating with TNFi or JAKi (hazard ratio [HR] for TNFi, 1.45, 95% CI 1.27-1.64; HR for JAKi, 1.43, 95% CI 1.19-1.72). CONCLUSION: These real-world findings suggest that abatacept as a 1L treatment has the potential to improve persistence in patients with anti-CCP+ and RF+RA compared to the most commonly used 1L alternatives.