Biologics utilization for rheumatoid arthritis in the United States: An observational longitudinal study

We describe patterns of treatment of rheumatoid arthritis with biologics in the United States during 2000–2010 using longitudinal data in the IMS LifeLink™ health plan claims database. Rheumatoid arthritis prevalent and incident cases were identified by ICD-9 diagnostic codes. The proportion of prevalent rheumatoid arthritis cases using biologics increased from 18.7% in 2005 to 26.3% in 2010. Tumor necrosis factor α antagonists constituted 99.1% of biologics in 2005 and 84.4% in 2010. During 2000–2010, 58.1% of incident cases were treated with 1st-line non-steroidal anti-inflammatory drugs and/or corticosteroids and 36.5% were treated with 1st-line synthetic disease-modifying anti-rheumatic drugs. Biologics constituted 5.4% of 1st-line therapies for incident rheumatoid arthritis cases and 30.9%–56.3% of 2nd-to-≥5th line therapies. For those who started on 1st-line non-steroidal anti-inflammatory drugs/corticosteroids, the duration of pharmacotherapy before switching to biologics was 7.2 years for those starting biologics in 2005–2007 and 4.2 years for those starting biologics in 2008–2010. In summary, the use of biologics as 1st-line treatment for rheumatoid arthritis remained relatively constant at about 5%, but the durations of treatment with other pharmacotherapies before starting biologics shrank.