FRI0113 Persistence and Adherence with Triple Therapy and Tumor Necrosis Factor Inhibitor-Methotrexate Combination Therapy in us Veterans with Rheumatoid Arthritis

BackgroundA randomized controlled trial (RTC) including US veterans with rheumatoid arthritis (RA) reported similar clinical efficacy, persistence, and adherence in a comparison of combination therapy with triple therapy (methotrexate [MTX] + hydroxychloroquine [HCQ] + sulfasalazine [SSZ]) versus tumor necrosis factor inhibitor-methotrexate (TNFi-MTX).1 In contrast, an analysis of US clinical practice based on claims data for commercially insured patients reported differences in persistence and adherence between these combinations.2ObjectivesTo report one-year persistence and adherence of triple therapy and TNFi-MTX in US Veterans initiating combination therapy to allow preliminary comparison of findings in clinical practice and RCT-reported data.MethodsUS veterans with RA initiating TNFi-MTX or triple therapy between Jan 1, 2006 and Dec 31, 2012 after 6-months of VA enrollment without prior combination therapy were evaluated for 12-months. The index date for starting combination therapy was defined as the date on which the final drug to complete each treatment combination was initiated. Three different definitions for termination of combination therapy were defined and persistence over one year calculated for each method. Method #1: ≥45-day gap for the TNFi or two drugs in triple therapy, or initiation of a non-TNFi biologic or new conventional DMARD; method #2: Same as #1 except switch to another TNFi in TNFi+MTX group or change in conventional DMARD was allowed; method #3: ≥45-day gap in any drug of the combination or initiation of any new biologic or conventional DMARD. Persistence on individual drugs within each therapy was assessed and defined as no ≥45-day gap for that drug. Adherence was defined as Proportion of Days Covered (PDC)>80% and determined for each individual drug and the combination of all drugs.ResultsA total of 2,936 TNFi-MTX patients and 1,125 triple therapy patients met the eligibility criteria (mean [SD] age at index 60.7 [10.8] vs. 61.8 [9.9], 13.0% vs. 9.0% female, mean [SD] Charlson comorbidity index 1.61 [1.03] vs. 1.81 [1.36]). After 12 months, persistence in the TNFi-MTX arm was significantly greater across all three approaches (p