Table 2.
Patient Demographics (at Index Date) and Clinical Characteristics (at Baseline)
| Parameter | All patients (N = 10,229) | TNF inhibitor cyclers (N = 6203) | TNF inhibitor-alternative MOA switchers (N = 2640) | P valuea | Alternative MOA cyclers (N = 699) | P valuea | Alternative MOA-TNF inhibitor switchers (N = 687) | P valuea |
|---|---|---|---|---|---|---|---|---|
| Age, yrs, mean ± SD | 50.3 ± 9.4 | 49.7 ± 9.6 | 51.0 ± 9.2 | <.001 | 52.0 ± 8.5 | <.001 | 51.0 ± 8.5 | <.001 |
| Sex, N (%) | ||||||||
| Male | 1808 (17.7) | 1167 (18.8) | 428 (16.2) | .004 | 112 (16.0) | .072 | 101 (14.7) | .008 |
| Female | 8421 (82.3) | 5036 (81.2) | 2212 (83.8) | 587 (84.0) | 586 (85.3) | |||
| Geographic region, N (%) | ||||||||
| Northeast | 1592 (15.6) | 983 (15.8) | 391 (14.8) | .016 | 110 (15.7) | .670 | 108 (15.7) | .170 |
| North Central | 2129 (20.8) | 1274 (20.5) | 569 (21.6) | 150 (21.5) | 136 (19.8) | |||
| South | 4488 (43.9) | 2657 (42.8) | 1197 (45.3) | 310 (44.3) | 324 (47.2) | |||
| West | 1932 (18.9) | 1238 (20.0) | 457 (17.3) | 123 (17.6) | 114 (16.6) | |||
| Unknown | 88 (0.9) | 51 (0.8) | 26 (1.0) | 6 (0.9) | 5 (0.7) | |||
| Residence, N (%) | ||||||||
| Urban | 8515 (83.2) | 5152 (83.1) | 2205 (83.5) | .410 | 586 (83.8) | .810 | 572 (83.3) | .990 |
| Rural | 1630 (15.9) | 1004 (16.2) | 409 (15.5) | 107 (15.3) | 110 (16.0) | |||
| Unknown | 84 (0.8) | 47 (0.8) | 26 (1.0) | 6 (0.9) | 5 (0.7) | |||
| Insurance plan type, N (%) | ||||||||
| Traditional | 379 (3.7) | 201 (3.2) | 118 (4.5) | <.001 | 33 (4.7) | .033 | 27 (3.9) | .370 |
| EPO/PPO | 6369 (62.3) | 3829 (61.7) | 1698 (64.3) | 411 (58.8) | 431 (62.7) | |||
| HMO | 1272 (12.4) | 831 (13.4) | 273 (10.3) | 76 (10.9) | 92 (13.4) | |||
| POS | 867 (8.5) | 532 (8.6) | 202 (7.7) | 74 (10.6) | 59 (8.6) | |||
| POS with capitation | 44 (0.4) | 26 (0.4) | 13 (0.5) | 3 (0.4) | 2 (0.3) | |||
| Other | 872 (8.5) | 528 (8.5) | 238 (9.0) | 64 (9.2) | 42 (6.1) | |||
| Unknown | 426 (4.2) | 256 (4.1) | 98 (3.7) | 38 (5.4) | 34 (4.9) | |||
| Index year, N (%) | ||||||||
| 2010 | 2206 (21.6) | 1492 (24.1) | 413 (15.6) | <.001 | 65 (9.3) | <.001 | 236 (34.4) | <.001 |
| 2011 | 2404 (23.5) | 1511 (24.4) | 526 (19.9) | 220 (31.5) | 147 (21.4) | |||
| 2012 | 1991 (19.5) | 1195 (19.3) | 575 (21.8) | 120 (17.2) | 101 (14.7) | |||
| 2013 | 2080 (20.3) | 1159 (18.7) | 654 (24.8) | 166 (23.7) | 101 (14.7) | |||
| 2014 | 1548 (15.1) | 846 (13.6) | 472 (17.9) | 128 (18.3) | 102 (14.8) | |||
| Length of follow-up, days, mean ± SD | 927.0 ± 439.3 | 943.9 ± 445.3 | 889.1 ± 417.3 | <.001 | 892.7 ± 427.2 | .004 | 954.5 ± 468.2 | .560 |
| Charlson Comorbidity Index score, mean ± SD | 1.4 ± 0.9 | 1.4 ± 0.8 | 1.5 ± 1.0 | <.001 | 1.6 ± 1.0 | <.001 | 1.6 ± 1.0 | <.001 |
| Targeted DMARDs, N (%) | ||||||||
| Abatacept IV | 661 (6.5) | 0 (0.0) | 0 (0.0) | 277 (39.6) | <.001 | 384 (55.9) | <.001 | |
| Abatacept SC | 130 (1.3) | 0 (0.0) | 0 (0.0) | 72 (10.3) | <.001 | 58 (8.4) | <.001 | |
| Adalimumab | 2819 (27.6) | 2051 (33.1) | 768 (29.1) | <.001 | 0 (0.0) | <.001 | 0 (0.0) | <.001 |
| Anakinra | 28 (0.3) | 0 (0.0) | 0 (0.0) | 14 (2.0) | <.001 | 14 (2.0) | <.001 | |
| Certolizumab | 286 (2.8) | 155 (2.5) | 131 (5.0) | <.001 | 0 (0.0) | <.001 | 0 (0.0) | <.001 |
| Etanercept | 4069 (39.8) | 3168 (51.1) | 901 (34.1) | <.001 | 0 (0.0) | <.001 | 0 (0.0) | <.001 |
| Golimumab IV | 1 (0.0) | 0 (0.0) | 1 (0.0) | .30 | 0 (0.0) | 0 (0.0) | ||
| Golimumab SC | 449 (4.4) | 303 (4.9) | 146 (5.5) | .21 | 0 (0.0) | <.001 | 0 (0.0) | <.001 |
| Infliximab | 1220 (11.9) | 526 (8.5) | 693 (26.3) | <.001 | 0 (0.0) | <.001 | 1 (0.1) | <.001 |
| Rituximab | 432 (4.2) | 0 (0.0) | 0 (0.0) | 274 (39.2) | <.001 | 158 (23.0) | <.001 | |
| Tocilizumab IV | 89 (0.9) | 0 (0.0) | 0 (0.0) | 46 (6.6) | <.001 | 43 (6.3) | <.001 | |
| Tocilizumab SC | 7 (0.1) | 0 (0.0) | 0 (0.0) | 4 (0.6) | <.001 | 3 (0.4) | .001 | |
| Tofacitinib | 38 (0.4) | 0 (0.0) | 0 (0.0) | 12 (1.7) | <.001 | 26 (3.8) | <.001 | |
| Targeted DMARD PDC, mean ± SD | 0.53 ± 0.27 | 0.53 ± 0.27 | 0.55 ± 0.27 | .011 | 0.47 ± 0.28 | <.001 | 0.50 ± 0.28 | .006 |
| No. of targeted DMARDs, mean ± SD | 1.03 ± 0.18 | 1.02 ± 0.13 | 1.02 ± 0.16 | .008 | 1.09 ± 0.29 | <.001 | 1.12 ± 0.35 | <.001 |
| Baseline csDMARDs, N (%) | ||||||||
| Hydroxychloroquine | 2367 (23.1) | 1478 (23.8) | 552 (20.9) | .003 | 172 (24.6) | .65 | 165 (24.0) | .91 |
| Leflunomide | 1736 (17.0) | 1004 (16.2) | 472 (17.9) | .051 | 148 (21.2) | <.001 | 112 (16.3) | .94 |
| Methotrexate | 5531 (54.1) | 3554 (57.3) | 1334 (50.5) | <.001 | 306 (43.8) | <.001 | 337 (49.1) | <.001 |
| Sulfasalazine | 806 (7.9) | 488 (7.9) | 201 (7.6) | .68 | 52 (7.4) | .69 | 65 (9.5) | .14 |
| Baseline total healthcare cost, $, mean ± SD | 41,195 ± 28,481 | 39,359 ± 25,939 | 44,673 ± 30,520 | <.001 | 44,739 ± 38,501 | <.001 | 40,802 ± 28,807 | .17 |
| Baseline RA-related cost, $, mean ± SD | 29,703 ± 18,395 | 29,059 ± 17,292 | 32,207 ± 21,045 | <.001 | 28,868 ± 16,682 | .78 | 26,737 ± 17,812 | <.001 |
| Outpatient office visits, mean ± SD | 5.5 ± 3.3 | 5.3 ± 3.1 | 5.8 ± 3.4 | <.001 | 6.4 ± 4.1 | <.001 | 6.4 ± 3.7 | <.001 |
a
P value compared with TNF inhibitor cyclers.
csDMARDs indicates conventional synthetic disease-modifying antirheumatic drugs; DMARD, disease-modifying antirheumatic drug; EPO, exclusive provider organization; HMO, health maintenance organization; IV, intravenous; MOA, mechanism of action; PDC, proportion of days covered; POS, point of service; PPO, preferred provider organization; RA, rheumatoid arthritis; SC, subcutaneous; SD, standard deviation; TNF, tumor necrosis factor.