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, Siebert, Stefan, Semple, Yvonne, Godman, Brian ORCID: 0000-0001-6539-6972, Maciel Almeida, Alessandra, Acurcio, Francisco de Assis 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 - e027059.

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Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p>To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective cohort.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Patients in secondary care receiving SC biologics in the largest Scottish Health Board.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Outcomes measured</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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%).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec>

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 13 Sep 2019 07:20
Last Modified: 17 Jan 2020 09:10
DOI: 10.1136/bmjopen-2018-027059
URI: http://livrepository.liverpool.ac.uk/id/eprint/3054425