TY - JOUR
T1 - Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases
T2 - A retrospective study
AU - Alvarez-Madrazo, Samantha
AU - Kavanagh, Kimberley
AU - Siebert, Stefan
AU - Semple, Yvonne
AU - Godman, Brian
AU - Maciel Almeida, Alessandra
AU - Acurcio, Francisco De Assis
AU - Bennie, Marion
N1 - Funding Information:
1Health Data Research Scotland, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK 2School of Public Health, Imperial College London, London, United Kingdom 3Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK 4Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK 5Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK 6Medicines Information, Pharmacy Department, Glasgow Royal Infirmary, Glasgow, UK 7Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden 8Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa 9Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil 10Information Services Division, NHS National Services Scotland, Edinburgh, UK Acknowledgements Farr Institute @ Scotland, GGC Safe Haven team, Norman Lannigan and Kevin Milne for providing the Homecare Database and allow its use for research purposes. FdAA acknowledges the support from Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), the Minas Gerais State Research Foundation, Brazil.
Funding Information:
We acknowledge the support from The Farr Institute @ Scotland. The Farr Institute @ Scotland is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates) and the Wellcome Trust (MRC Grant No: MR/K007017/1).
Funding Information:
Funding We acknowledge the support from The Farr Institute @ Scotland. The Farr Institute @ Scotland is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates) and the Wellcome Trust (MRC Grant No: MR/K007017/1).
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objectives To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design Retrospective cohort. Setting Patients in secondary care receiving SC biologics in the largest Scottish Health Board. Participants 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. Outcomes measured 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). Results 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%). Conclusion 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.
AB - Objectives To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design Retrospective cohort. Setting Patients in secondary care receiving SC biologics in the largest Scottish Health Board. Participants 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. Outcomes measured 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). Results 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%). Conclusion 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.
KW - adherence
KW - ankylosing spondylitis
KW - biologics
KW - persistence
KW - psoriatic arthritis
KW - rheumatoid arthritis
UR - http://www.scopus.com/inward/record.url?scp=85071764302&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2018-027059
DO - 10.1136/bmjopen-2018-027059
M3 - Article
C2 - 31488467
AN - SCOPUS:85071764302
VL - 9
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 9
M1 - e27059
ER -