An analysis presented at ACR Convergence highlights a shift in rheumatoid arthritis (RA) treatment patterns, with declining use of conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARD) and a rise in biologic and targeted synthetic (b/ts) DMARDs that indicates evolving clinician and patient preferences.

The research was presented by Jeffrey Sparks, MD, an associate professor of medicine at Harvard Medical School and rheumatologist at Brigham & Women’s Hospital in Boston, Massachusetts.

Sparks and colleagues analyzed long-term trends in the initiation DMARDs among adults with RA in the United States from 2001 to 2021. Using a US commercial claims database, the researchers identified 407,728 DMARD initiation episodes among 229,365 unique RA patients (median age: 50; 79.4% female). The study categorized DMARDs into conventional synthetics (csDMARDs), biologics (bDMARDs), and targeted synthetics (tsDMARDs) and examined trends in initial DMARD choices, the use of non-csDMARDs as first-line treatments, and biosimilar uptake.

Findings revealed a significant decline in csDMARD initiations from 79.7% in 2001 to 54.7% in 2021 (p < 0.001), reflecting a shift towards newer therapies. Over the same period, bDMARD initiations rose from 20.3% to 33.1% (p < 0.001), while tsDMARDs saw a substantial increase from 0.1% in 2014 to 12.2% by 2021 (p < 0.001). Methotrexate remained the most commonly initiated DMARD but decreased from 28.7% to 15.0% of initiations (p < 0.001).

Among biologics, adalimumab was consistently popular, accounting for 13.3% of bDMARD initiations in 2003 and 12.2% in 2021. Tofacitinib was the leading tsDMARD until 2019, after which its use declined as upadacitinib became more common, reaching 7.6% in 2021. Despite the increasing availability of biosimilars, their use remained below 1% over the study period.

As newer DMARDs and biosimilars enter the market, further research is warranted to assess their impact on treatment decisions and patient outcomes, the investigators concluded.

Reference
Sparks J. Trends in initiation of disease-modifying antirheumatic drugs for rheumatoid arthritis among commercially-insured us adults, 2001-2021. Presented at: American College of Rheumatology. November 14-19, 2024; Washington, DC.