Rates, factors, reasons, and economic impact associated with switching in rheumatoid arthritis patients newly initiated on biologic disease modifying anti-rheumatic drugs in an integrated healthcare system.

Objectives To identify how many RA patients newly-initiated on bDMARD therapy switch to another bDMARD during the first year of treatment; to evaluate the factors and reasons associated with bDMARD switching; and to compare the RA-related healthcare resource utilization (HCRU) and costs between switchers vs non-switchers during the post-index period. Methods A retrospective cohort study was conducted in RA patients using the Kaiser Permanente Southern California (KPSC) database with the study time period of January 1, 2007 to December 31, 2012. The index date was defined as the date of the first bDMARD prescription. Patients had to have continuous membership eligibility with drug benefit and no prior history of bDMARD during the 24 months prior to the index date. bDMARD switching was defined as a different bDMARD claim during post-index. A multivariable logistic regression model was used to evaluate factors associated with switchers vs non-switchers. Chart notes were reviewed to evaluate reasons for switching from index bDMARD. RA-related HCRU use and costs were evaluated using a generalized linear model (GLM) with gamma distribution and log link function. Results Two hundred and fifty-one patients (12%) switched from their index bDMARD to a different bDMARD during the post-index period. bDMARD switchers were more likely to be female, of Asian/Pacific race, younger than ≤65 years of age, overweight, CCI score ≤2, initiating etanercept or adalimumab, and have a commercial insurance plan compared to non-switchers. Reasons for switching were related mostly to lack or loss of efficacy (∼51%); bDMARD switchers had overall mean adjusted RA related total costs that were 25% higher (p = 0.04) compared to non-switchers. Conclusion It is important for RA patients to receive appropriate therapy and consider bDMARD with different mechanisms of action to decrease subsequent switching, and decrease overall RA related costs as shown in this study.

A Descriptive Evaluation of Prescriber Perceptions and Experience With Risk Evaluation and Mitigation Strategy (REMS) Programs in an Integrated Health Care System.

OBJECTIVE: To assess prescriber perceptions and experience with risk evaluation and mitigation strategy (REMS) programs in an integrated health care delivery system. METHODS: A cross-sectional online survey was e-mailed to eligible health care prescribers if they prescribed at least 1 selected REMS-related product within 6 months spanning January 1 to June 30, 2013; were an active employee of Kaiser Permanente Southern California; and had an active " kp.org " e-mail address. Descriptive analyses were conducted on the survey responses. RESULTS: Three hundred sixty-four respondents (34%) completed the online survey. The majority were primary care prescribers (65%) versus nonprimary prescribers. The majority of primary care, oncologist, and specialist prescribers responded that REMS was meaningful, improved patient safety, and made an impact on their patient interactions. The majority of surgeons and pain management prescribers responded that REMS was not meaningful, did not improve safety for the patients, or did not impact their interactions with their patients. Over 50% of prescribers counseled their patients or had another health care team member discuss the risks and benefits of these REMS-related medications; medication guides or other printed literature was not provided as much. CONCLUSION: The results from the survey suggest that prescriber specialty has an impact on the perceived value of the REMS program and the perceived need to counsel patients regarding medications with REMS programs.