Abstract
Background: Currently, real-world data on rheumatoid arthritis (RA) treatment patterns in France are limited.Objectives: The aim of this study was therefore to describe, between 2013 and 2017, the sequence of therapies used in the treatment of patients with RA and to characterize RA treatment patterns using real-world data.Methods: A non-interventional, longitudinal study was conducted using the Echantillon Généraliste des Bénéficiaires (EGB) between 1 January 2013 and 31 December 2017. EGB is a 1/97th representative random sample from the French National Healthcare Database (SNDS) which includes claims data covering 99% of the total French population. Treatment patterns, adherence and persistence of RA treatments were described in a cohort of patients with RA, identified between 2013 and 2017.Results: Between 2013 and 2017, 2,553 patients with RA were identified, including 2,314 in 2017. Of the 2,314 RA patients identified in 2017 (mean age 66.2 ± 15.4 years; 73.7% female; mean Charlson comorbidity score 4.2), 1,102 (47.6%) did not receive any disease-modifying anti-rheumatic drug (DMARD). Of these, 944 (85.7%) had received at least one symptomatic treatment, including 862 (91.3%) an analgesic, 509 (53.9%) an oral corticosteroid and 384 (40.7%) non-steroidal anti-inflammatory drugs.Of the 2,553 RA patients monitored between 2013 and 2017, 1,512 (59.2%) patients received a DMARD, of which 721 (47.7%) patients received only one treatment sequence, mainly methotrexate (n=529, 35.0%), and did not discontinue or switch treatment. Switching treatment to a targeted DMARD was reported for 144 (9.5%) patients. During follow-up, 377 (25%) patients discontinued treatment. In total, 1,142 RA treatment initiations were recorded, 62.4% of which were conventional synthetic DMARDs (csDMARDs). Persistence rates (95% confidence interval) for csDMARDs, TNF inhibitors (TNFi) and other targeted DMARDs (tDMARDs) were 63.4% (59.6–67.0), 55.9% (49.2–62.0) and 59.4% (51.2–66.6) at 12 months, respectively; Medication Possession Ratio (MPR), an adherence indicator, was 80.5%, 90.8% and 71.9%, respectively.Long-term oral corticosteroids (≥6 months) were also associated with csDMARD for 42.6% of cases (n=304/713), TNFi for 39.7% (n=100/252) and another tDMARD for 53.1% (n=94/177). The average doses of long-term oral corticosteroids were 7.5 mg, 6.5 mg and 7.8 mg of prednisone equivalent per day, respectively.Conclusion: Using data obtained from the EGB, this study estimated the number of patients with RA in France to be 307,612 in 2017. Approximately half of the patients identified in the EGB cohort were not treated with a DMARD. For a substantial proportion of patients receiving DMARDs, therapeutic escalation, a switch in treatment, or long-term corticosteroid co-therapy with an average daily dose greater than 5 mg were needed. Furthermore, median persistence for most targeted DMARDs was less than 2 years, and the early discontinuation rates of up to 46.6% suggest poor DMARD tolerance in many patients.This study highlights that the medical need for RA treatment is not covered by current therapeutic strategies.