Insight on how rheumatologists are utilizing biologics in RA treatment

BioTrends Research Group has released ChartTrends: Biologics in Rheumatoid Arthritis, a syndicated publication offering comprehensive insight into the management of RA patients. The report is based on a comparison of self-reported treatment approaches (as reported by 208 rheumatologists) with actual patient level data for over 1,000 RA patients who are currently being treated with biologic agents.

To be eligible for the audit, patients had to currently be treated with a biologic agent (UCB's Cimzia, Amgen/Wyeth's Enbrel, Abbott's Humira, Bristol Myers Squibb's Orencia , Centocor-Ortho Biotech's Remicade and Simponi, or Genentech's Rituxan). Each brand was represented by at least 98 patient charts and rheumatologists were limited to one audit per brand. The aim of ChartTrends is to understand actual treatment algorithms for the biologic brands and to clearly understand the "patient types" being treated with these agents. The audit captured patient demographic variables, co-morbidities, concomitant medications (including DMARD dose and strategy), disease history from diagnosis, biologic initiation, dose titration, brand switching, current clinical status and results from the most recent laboratory and radiographic tests.

Among the audited patients, 30% had their disease classified as severe. 76% of the patients were female, average age was 54 and overall, patients had been followed by their current rheumatologist for 54 months. The majority of patients are currently prescribed concomitant DMARD therapy, such as methotrexate, although the prevalence varied by brand. While Rheumatologists have reported a more aggressive use of biologic agents, this study confirms these reports by demonstrating that the time between original RA diagnosis and biologic initiation has decreased significantly over the past five years.

First-line use was most common with Enbrel and Humira, while Rituxan and Orencia were more commonly later line choices. Despite an indication for use after DMARD failure, more than three quarters of the Orencia patients (n=155) were not started on the therapy until at least one TNF-alpha failure. The two new TNF-alpha treatments, UCB's Cimzia and Centocor Ortho-Biotech's Simponi, are drawing from both biologic naive and switch patients. These new products have significantly higher rates of prior authorization required compared to other biologic agents.

Physicians were also presented with three new agents currently under development for RA, Roche's Actemra, GSK's Arzerra and Pfizer's CP-690. Rheumatologists have greatest familiarity with Actemra, but expressed highest interest in CP-690. The newer TNF-alpha agents (Simponi and Cimzia) along with the alternate mechanism of action agents Orencia and Rituxan appear to be at greatest risk from new entrants into the RA biologic market.