Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study.

Alvarez-Madrazo, Samantha ORCID: 0000-0003-2026-8533, Kavanagh, Kimberley ORCID: 0000-0002-2679-5409, Siebert, Stefan ORCID: 0000-0002-1802-7311, Semple, Yvonne, Godman, Brian ORCID: 0000-0001-6539-6972, Maciel Almeida, Alessandra, Acurcio, Francisco de Assis ORCID: 0000-0002-5880-5261 and Bennie, Marion (2019) Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study. BMJ open, 9 (9). e027059-.

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Official URL: http://dx.doi.org/10.1136/bmjopen-2018-027059

Abstract

<h4>Objectives</h4>To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service.<h4>Design</h4>Retrospective cohort.<h4>Setting</h4>Patients in secondary care receiving SC biologics in the largest Scottish Health Board.<h4>Participants</h4>A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included.<h4>Outcomes measured</h4>A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR).<h4>Results</h4>751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days' follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%).<h4>Conclusion</h4>Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.

Item Type:	Article
Uncontrolled Keywords:	Humans, Musculoskeletal Diseases, Rheumatic Diseases, Antirheumatic Agents, Biological Products, Injections, Subcutaneous, Retrospective Studies, Drug Resistance, Adult, Middle Aged, Drug Utilization Review, Scotland, Female, Male, Medication Adherence, Drug Substitution
Depositing User:	Symplectic Admin
Date Deposited:	13 Sep 2019 07:20
Last Modified:	18 Mar 2024 04:19
DOI:	10.1136/bmjopen-2018-027059
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3054425