Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: Persistence and dosing patterns in Germany

Research output: Contribution to journalArticleResearchpeer review

Authors

  • Sarah Neubauer
  • Mary Cifaldi
  • Thomas Mittendorf
  • Arijit Ganguli
  • Malte Wolff
  • Jan Zeidler

External Research Organisations

  • AbbVie
  • Xcenda GmbH
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Details

Original languageEnglish
Article number32
Pages (from-to)1-11
Number of pages11
JournalHealth Economics Review
Volume4
Issue number1
Early online date23 Nov 2014
Publication statusPublished - 1 Dec 2014

Abstract

Objective: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as “TNF inhibitor naive” or “TNF inhibitor continuing”. For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.

Keywords

    Claims data, Dosing patterns, Germany, Persistence, Rheumatoid arthritis, Tumor necrosis factor inhibitor

ASJC Scopus subject areas

Sustainable Development Goals

Cite this

Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: Persistence and dosing patterns in Germany. / Neubauer, Sarah; Cifaldi, Mary; Mittendorf, Thomas et al.
In: Health Economics Review, Vol. 4, No. 1, 32, 01.12.2014, p. 1-11.

Research output: Contribution to journalArticleResearchpeer review

Neubauer, S, Cifaldi, M, Mittendorf, T, Ganguli, A, Wolff, M & Zeidler, J 2014, 'Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: Persistence and dosing patterns in Germany', Health Economics Review, vol. 4, no. 1, 32, pp. 1-11. https://doi.org/10.1186/s13561-014-0032-4
Neubauer, S., Cifaldi, M., Mittendorf, T., Ganguli, A., Wolff, M., & Zeidler, J. (2014). Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: Persistence and dosing patterns in Germany. Health Economics Review, 4(1), 1-11. Article 32. https://doi.org/10.1186/s13561-014-0032-4
Neubauer S, Cifaldi M, Mittendorf T, Ganguli A, Wolff M, Zeidler J. Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: Persistence and dosing patterns in Germany. Health Economics Review. 2014 Dec 1;4(1):1-11. 32. Epub 2014 Nov 23. doi: 10.1186/s13561-014-0032-4
Neubauer, Sarah ; Cifaldi, Mary ; Mittendorf, Thomas et al. / Biologic TNF inhibiting agents for treatment of rheumatoid arthritis : Persistence and dosing patterns in Germany. In: Health Economics Review. 2014 ; Vol. 4, No. 1. pp. 1-11.
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title = "Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: Persistence and dosing patterns in Germany",
abstract = "Objective: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as “TNF inhibitor naive” or “TNF inhibitor continuing”. For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.",
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T2 - Persistence and dosing patterns in Germany

AU - Neubauer, Sarah

AU - Cifaldi, Mary

AU - Mittendorf, Thomas

AU - Ganguli, Arijit

AU - Wolff, Malte

AU - Zeidler, Jan

N1 - Funding Information: This work was supported by AbbVie Inc. Publisher Copyright: © 2014, Neubauer et al. licensee Springer.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Objective: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as “TNF inhibitor naive” or “TNF inhibitor continuing”. For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.

AB - Objective: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as “TNF inhibitor naive” or “TNF inhibitor continuing”. For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.

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