Managing Rheumatoid Arthritis: An Overview of New Research

The utilization of biologics for rheumatoid arthritis and the management of the condition by specialty pharmacies are examined in 2 new studies from The American Journal of Pharmacy Benefits and The American Journal of Managed Care.

Two new rheumatoid arthritis (RA) articles on the impact of American College of Rheumatology (ACR) treatment guidelines on drug utilization trends and the management costs in RA have been published in The American Journal of Pharmacy Benefits (AJPB) and The American Journal of Managed Care (AJMC), respectively.

In the AJPB study, the authors examined how the utilization of drugs to treat RA has changed since the the ACR provided guidelines for the use of biologic agents in 2008. They noted that the 2008 guidelines and 2012 update recommended the use of biologic agents in new and early cases of RA. Using data from a CVS Caremark longitudinal study, investigators compared the use of conventional disease-modifying antirheumatic drugs (DMARDs) with the use of biologics to treat the condition.

The researchers found that since 2006, the relative use of conventional DMARD therapy “has steadily declined compared with utilization of biologics.” From 2006 to 2011, the use of these antirheumatic drugs decreased 27%, whereas the relative utilization of biologic therapy has doubled over the same time period. “We observed a significant shift to biologics as a percentage of overall utilization, as well an increase in the overall PMPY [per member per year] costs of 24%, while per utilizer costs grew only 9%,” the authors wrote.

Revised treatment guidelines incorporating the use of biologics and several innovative treatments in the RA pipeline, specifically tofacitinib and fostamatinib disodium, are the cause of this shift in RA treatment, asserted the authors. Biologics are expected to continue to influence treatment decisions and preferred reimbursement of tofacitinib would likely influence its uptake, “provided it gains approval as a potential front-line agent after methotrexate.”

As a result of this increase in the use of biologic agents, it should come as no surprise that RA will be associated with significant treatment costs. According to an article published in AJMC, this treatment can be cost effective if it is delivered in a structured and timely manner and if it is based on the “prevention of disease progression and improved work productivity associated with disease control.”

In his assessment, William J. Cardarelli, PharmD, outlined the direct costs of RA, such as physician visits, ambulatory care visits, joint imaging, lab work, joint aspiration and injection, and nerve conduction studies. He also pointed out that most indirect costs lie with the productivity and quality of life of the patient, noting that “work disability associated with RA has been estimated to be 3 times as expensive as the direct medical costs of managing the disease.” He also summarized various studies in which the management of medications through specialty pharmacies helped control cost and improved patient outcomes.

Optimal disease management comes with the help of the services of a specialty pharmacy, Dr. Cardarelli maintained. Specialty pharmacies can assist patients in obtaining prior authorizations, managing utilization, and remaining adherent to their prescriptions. They are also effective in providing educational training to both physicians and patients, determining dosing, quantity, and therapy limits, selecting alternative treatment pathways when the first line of treatment fails, and helping patients with cost-sharing issues.

Specialty pharmacies and their disease therapy management programs “can assist patients by providing structure, education, and mechanisms to improve patient adherence in order to optimize therapy,” Dr. Caradarelli concluded.