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Mapping the Prescription Trend for Rheumatoid Arthritis in Mumbai, India
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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
in 1,000 KRW: 1,097±607, 1,302±554 vs. 741±531, p< 0.001). In multivariate regression analyses, significant positive associations with high LPT were shown in high (adjusted OR = 6.16, 95% CI: 3.6-10.5) and moderate DAS (adjusted OR = 2.63, 95% CI: 2.01-3.44) compared to low DAS. Also, significant positive associations with high monthly cost of LPT were shown in high (adjusted OR = 5.58, 95% CI: 3.35-9.30) and moderate DAS (adjusted OR = 2.65, 95% CI: 2.03-3.45) compared to low DAS. Conclusions: Patients with higher DAS appeared to have worse productivity loss outcomes. Early strategic therapeutic approach for RA patients with moderate to high DAS showing strong associations with high productivity loss is needed to minimize socio-economic burdens.
Muscular-Skeletal Disorders – Health Care Use & Policy Studies PMS18 Treatment Gap of Post Osteoporotic Fractures in Taiwan: A Nationwide Cohort Study, 2008-2013 Wang C1, Fu S2, Huang C2, Hung C2, Huang S1, Lin C3, Hsiao F3 of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, Yunlin, Taiwan, 3National Taiwan University, Taipei, Taiwan 1School
Objectives: Well-documented evidences have recommended patients who experience hip or spine fracture to receive anti-osteoporosis drugs. However, a treatment gap in pharmacological prevention of subsequent osteoporotic fractures was a current concern. This study aims at evaluate the treatment gap and prescription pattern of anti-osteoporosis drugs in Taiwanese population. Methods: Using Taiwan’s National Health Insurance Research database (NHIRD), we identified patients with a diagnosis of osteoporosis or users of anti-osteoporosis drugs [bisphosphonate, raloxifene, denosumab or teriparatide] from 2008 to 2013 as an osteoporosis cohort. From this cohort, we further identified those who were newly diagnosed with hip or spine fracture within 2009-2012 as our study subjects. The first diagnosis date of hip or spine fracture was defined as the index date for each of our study subject. Treatment gap were measured as the proportion of receiving anti-osteoporosis drugs within one year after the index date among our study subjects. The categories and timing of initiating anti-osteoporosis drugs were also examined. Results: Our study included 283,399 patients with newly diagnosed hip or spine fracture between 2009 and 2012. Approximately two-third of them were female. The mean age of our study subjects were 67 and 71 years old for male and female, respectively. Treatment gap of post osteoporotic fractures differed by gender. The proportion of patients received anti-osteoporosis drugs within one year after the index date ranged from 10 to 15 % for male and 26 to 32% for female. Alendronate was the most frequently prescribed anti-osteoporosis drug for our study subjects. More than 50% of anti-osteoporosis drug users received their first prescription within 28 days after the index date. Conclusions: The proportion of patient received treatment within one year after index fracture was suboptimal in Taiwan, especially for male. More effects are warranted to improve the postfracture care in Taiwanese patients. PMS19 Persistence with Biologic Agents for the Treatment of Rheumatoid Arthritis in Japan Mahlich JC1, Sruamsiri R2 1Janssen KK, Tokyo, Japan, 2Janssen Pharmaceutical KK, Tokyo, Japan
Objectives: To assess persistence rates of biologic agents for the treatment of rheumatoid arthritis (RA) in Japan. Methods: Based on Japanese claims data of 16,214 patients between 2012 and 2014, 6 month, 12 month, and 18 month persistence rates of different biologic agents were calculated. Determinants of persistence were assessed by means of a multivariate Cox proportional hazard model controlling for age, sex, and comorbidities. A sensitivity analysis was performed with different definitions of persistence and a parametric survival analysis. Results: Overall persistence rates in Japan are high and reach 86% after one year in the entire sample. The persistence rate for the biologic naïve subpopulation is above 95%. Persistence is higher for older patients (HR 0.60 (95%CI 0.40-0.91) for > 75 years compared to
≤ 60 years) and lower for patients with a high comorbidity score (HR 1.13; 95%CI 1.05-1.60 for CCI score 3-5 compared to CCI score ≤ 2). We found a high variation of persistence between different drugs. Conclusions: Japanese RA patients have a high persistence rate of biologic treatments. However, multi-factors affect the persistence rate of Japanese patients including age, comorbidities and patient type. Naïve patients tend to have high persistence rate than continuing biologic patients. PMS20 Treatment Patterns of Rheumatoid Arthritis in Japanese Hospitals and Predictors of Initiation Biologic Agents Mahlich JC1, Sruamsiri R2 1Janssen KK, Tokyo, Japan, 2Janssen Pharmaceutical KK, Tokyo, Japan
Objectives: We describe the usage of different biologic agents in Japan over time and try to identify factors that affect the decision to initiate treatment with biologic agents. We also analyse determinants of a switch to another biologic agent for patients who are already on biologic treatment. Methods: We utilize a hospital claims data base with 36504 Japanese patients with a confirmed RA diagnosis. To analyse the determinants of treatment choices, we apply logistic regression analysis taking socio-demographic and medical factors into account. Results: 19.6% of treated patients in Japan receive a biologic agent. Significant factors that are associated with biologic treatment initiation include younger age, female sex, and a higher comorbidity index. The route of administration plays a major role when it comes to the switch between different biologic agents. Conclusions: The lower likelihood of elderly patients to be switched to a biologic might be due to risk aversion of Japanese physicians’ and patients who are afraid of potential side effects of biologics. This finding is also consistent with the notion of an age bias that impedes elderly patients from optimal access to biologic treatment.
PMS21 Mapping the Prescription Trend for Rheumatoid Arthritis in Mumbai, India Kulkarni AS, Kelkar RS, Majumdar AS Bombay College of Pharmacy, Mumbai, India
Objectives: The drugs used for treatment of Rheumatoid Arthritis (RA) fall under one of the following categories: Disease Modifying Anti-Rheumatic Drugs (DMARDs), Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Immunosuppressants, Steroids and Biologics. This research aims to explore and map the Prescribing Behavior of Medical Practitioners for disease management of RA. Methods: A questionnaire based survey was employed to capture the demographics of RA and the prescription pattern covering General Physicians, Orthopedics and Rheumatologists in Mumbai, India. The survey featured questions to reveal: a) Gender predisposition to Rheumatoid Arthritis. b) Age of patients c) Drug preference in therapy (single or combination) including biologics. Results: The survey revealed that women are more predisposed to RA than men and the ratio was approximately found to be 4:1. Amongst the patients diagnosed with RA, 86.36% were found to lie in the age group of 30-50. As a first line therapy, 31.81% of Medical Practitioners considered mono therapy with Methotrexate to be clinically most effective followed by combination therapy with Methotrexate + Hydroxychloroquine (27%). Doctors also preferred triple combination therapy of Methotrexate + Salfasalazine + Hydroxychloroquine as it had shown satisfactory clinical outcomes. 40% of Medical Practitioners were found to prescribe Leflunomide in conjunction with the first line therapy drugs. 45.45% of the Medical Practitioners recommended the use of Monoclonal Antibodies like Etanercept, Rituximab and Adalimumab as a therapy for patients who failed to respond to NSAIDs and DMARDs. Conclusions: No specific trend was observed in the prescriptions of NSAIDs as a choice of drug since a myriad of drugs are prescribed including Paracetamol, Indomethacin, Aceclofenac and Naproxen. A robust trend was observed in the prescriptions of Methotrexate either alone or as a combination with Hydroxychloroquine. Folinic acid was co prescribed by majority physicians to contain side effects. Amongst biologics, the most preferred was the TNF-alpha inhibitor-Etanercept.
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
in 1,000 KRW: 1,097±607, 1,302±554 vs. 741±531, p< 0.001). In multivariate regression analyses, significant positive associations with high LPT were shown in high (adjusted OR = 6.16, 95% CI: 3.6-10.5) and moderate DAS (adjusted OR = 2.63, 95% CI: 2.01-3.44) compared to low DAS. Also, significant positive associations with high monthly cost of LPT were shown in high (adjusted OR = 5.58, 95% CI: 3.35-9.30) and moderate DAS (adjusted OR = 2.65, 95% CI: 2.03-3.45) compared to low DAS. Conclusions: Patients with higher DAS appeared to have worse productivity loss outcomes. Early strategic therapeutic approach for RA patients with moderate to high DAS showing strong associations with high productivity loss is needed to minimize socio-economic burdens.
Muscular-Skeletal Disorders – Health Care Use & Policy Studies PMS18 Treatment Gap of Post Osteoporotic Fractures in Taiwan: A Nationwide Cohort Study, 2008-2013 Wang C1, Fu S2, Huang C2, Hung C2, Huang S1, Lin C3, Hsiao F3 of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan, Yunlin, Taiwan, 3National Taiwan University, Taipei, Taiwan 1School
Objectives: Well-documented evidences have recommended patients who experience hip or spine fracture to receive anti-osteoporosis drugs. However, a treatment gap in pharmacological prevention of subsequent osteoporotic fractures was a current concern. This study aims at evaluate the treatment gap and prescription pattern of anti-osteoporosis drugs in Taiwanese population. Methods: Using Taiwan’s National Health Insurance Research database (NHIRD), we identified patients with a diagnosis of osteoporosis or users of anti-osteoporosis drugs [bisphosphonate, raloxifene, denosumab or teriparatide] from 2008 to 2013 as an osteoporosis cohort. From this cohort, we further identified those who were newly diagnosed with hip or spine fracture within 2009-2012 as our study subjects. The first diagnosis date of hip or spine fracture was defined as the index date for each of our study subject. Treatment gap were measured as the proportion of receiving anti-osteoporosis drugs within one year after the index date among our study subjects. The categories and timing of initiating anti-osteoporosis drugs were also examined. Results: Our study included 283,399 patients with newly diagnosed hip or spine fracture between 2009 and 2012. Approximately two-third of them were female. The mean age of our study subjects were 67 and 71 years old for male and female, respectively. Treatment gap of post osteoporotic fractures differed by gender. The proportion of patients received anti-osteoporosis drugs within one year after the index date ranged from 10 to 15 % for male and 26 to 32% for female. Alendronate was the most frequently prescribed anti-osteoporosis drug for our study subjects. More than 50% of anti-osteoporosis drug users received their first prescription within 28 days after the index date. Conclusions: The proportion of patient received treatment within one year after index fracture was suboptimal in Taiwan, especially for male. More effects are warranted to improve the postfracture care in Taiwanese patients. PMS19 Persistence with Biologic Agents for the Treatment of Rheumatoid Arthritis in Japan Mahlich JC1, Sruamsiri R2 1Janssen KK, Tokyo, Japan, 2Janssen Pharmaceutical KK, Tokyo, Japan
Objectives: To assess persistence rates of biologic agents for the treatment of rheumatoid arthritis (RA) in Japan. Methods: Based on Japanese claims data of 16,214 patients between 2012 and 2014, 6 month, 12 month, and 18 month persistence rates of different biologic agents were calculated. Determinants of persistence were assessed by means of a multivariate Cox proportional hazard model controlling for age, sex, and comorbidities. A sensitivity analysis was performed with different definitions of persistence and a parametric survival analysis. Results: Overall persistence rates in Japan are high and reach 86% after one year in the entire sample. The persistence rate for the biologic naïve subpopulation is above 95%. Persistence is higher for older patients (HR 0.60 (95%CI 0.40-0.91) for > 75 years compared to
≤ 60 years) and lower for patients with a high comorbidity score (HR 1.13; 95%CI 1.05-1.60 for CCI score 3-5 compared to CCI score ≤ 2). We found a high variation of persistence between different drugs. Conclusions: Japanese RA patients have a high persistence rate of biologic treatments. However, multi-factors affect the persistence rate of Japanese patients including age, comorbidities and patient type. Naïve patients tend to have high persistence rate than continuing biologic patients. PMS20 Treatment Patterns of Rheumatoid Arthritis in Japanese Hospitals and Predictors of Initiation Biologic Agents Mahlich JC1, Sruamsiri R2 1Janssen KK, Tokyo, Japan, 2Janssen Pharmaceutical KK, Tokyo, Japan
Objectives: We describe the usage of different biologic agents in Japan over time and try to identify factors that affect the decision to initiate treatment with biologic agents. We also analyse determinants of a switch to another biologic agent for patients who are already on biologic treatment. Methods: We utilize a hospital claims data base with 36504 Japanese patients with a confirmed RA diagnosis. To analyse the determinants of treatment choices, we apply logistic regression analysis taking socio-demographic and medical factors into account. Results: 19.6% of treated patients in Japan receive a biologic agent. Significant factors that are associated with biologic treatment initiation include younger age, female sex, and a higher comorbidity index. The route of administration plays a major role when it comes to the switch between different biologic agents. Conclusions: The lower likelihood of elderly patients to be switched to a biologic might be due to risk aversion of Japanese physicians’ and patients who are afraid of potential side effects of biologics. This finding is also consistent with the notion of an age bias that impedes elderly patients from optimal access to biologic treatment.
PMS21 Mapping the Prescription Trend for Rheumatoid Arthritis in Mumbai, India Kulkarni AS, Kelkar RS, Majumdar AS Bombay College of Pharmacy, Mumbai, India
Objectives: The drugs used for treatment of Rheumatoid Arthritis (RA) fall under one of the following categories: Disease Modifying Anti-Rheumatic Drugs (DMARDs), Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Immunosuppressants, Steroids and Biologics. This research aims to explore and map the Prescribing Behavior of Medical Practitioners for disease management of RA. Methods: A questionnaire based survey was employed to capture the demographics of RA and the prescription pattern covering General Physicians, Orthopedics and Rheumatologists in Mumbai, India. The survey featured questions to reveal: a) Gender predisposition to Rheumatoid Arthritis. b) Age of patients c) Drug preference in therapy (single or combination) including biologics. Results: The survey revealed that women are more predisposed to RA than men and the ratio was approximately found to be 4:1. Amongst the patients diagnosed with RA, 86.36% were found to lie in the age group of 30-50. As a first line therapy, 31.81% of Medical Practitioners considered mono therapy with Methotrexate to be clinically most effective followed by combination therapy with Methotrexate + Hydroxychloroquine (27%). Doctors also preferred triple combination therapy of Methotrexate + Salfasalazine + Hydroxychloroquine as it had shown satisfactory clinical outcomes. 40% of Medical Practitioners were found to prescribe Leflunomide in conjunction with the first line therapy drugs. 45.45% of the Medical Practitioners recommended the use of Monoclonal Antibodies like Etanercept, Rituximab and Adalimumab as a therapy for patients who failed to respond to NSAIDs and DMARDs. Conclusions: No specific trend was observed in the prescriptions of NSAIDs as a choice of drug since a myriad of drugs are prescribed including Paracetamol, Indomethacin, Aceclofenac and Naproxen. A robust trend was observed in the prescriptions of Methotrexate either alone or as a combination with Hydroxychloroquine. Folinic acid was co prescribed by majority physicians to contain side effects. Amongst biologics, the most preferred was the TNF-alpha inhibitor-Etanercept.