Pharmacoepidemiology
Adherence Differences Between Infusible and Injectable Biologics Among Patients with Rheumatoid Arthritis During the COVID-19 National Emergency Jonathan P DeShazo* Jonathan DeShazo Djeneba Audrey Djibo Erick Moyneur Cheryl Walraven-McMahill
Background: Patients must adhere to the therapeutic regimen to achieve the best clinical outcomes. COVID-19 presented numerous barriers to RA patients taking biologics, particularly those receiving infusions in a healthcare setting. Previous work has suggested a decrease in infusible biologic adherence for non-RA conditions, yet the effect on RA infusible therapy as well as non-infusible RA therapy (e.g., self-injection) are unknown.
Objective: To assess changes in adherence during the COVID-19 emergency among RA patients taking infusible and injectable biologics.
Methods: We conducted a retrospective, repeated, cross -sectional analysis of administrative claims for enrollees aged 18 years and above with an RA diagnosis and established on a biologic. We compared medication possession patio (MPR) and persistence among independent cohorts for 2019, 2020, and 2021 using a mixed model adjusting for age, race, and comorbidity. The analysis window was March 1 until discontinuation or December 31 of the cohort year. Persistence was calculated as days between March 1 and last dispense, plus last days’ supply. MPR was calculated as days’ supply dispensed divided by days in analysis window.
Results: Cohort 2019 (n=6,246), Cohort 2020(n=7,771), and Cohort 2021(n=7051) were comparable in biologics, sex, ethnicity, history of specific comorbidities, and combined comorbidity score.
2020 had significantly lower MPR compared to 2019 for most of the injection biologics(p<.001). This was followed by a significant increase in 2021 MPR(p<.001). MPR drops were not measured in either infusion-only biologic, but Rituximab persistence decreased in 2020(p<.001).
Conclusions: Adherence among RA patients taking most biologics declined in 2020, exhibited by lower MPR in some injectables and lower persistence in some infusions. This work suggests that COVID-19 impacted biologic adherence among RA patients in ways more complex than previously considered.
