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Introduction <p>Patients with rheumatoid arthritis (RA) often fail to achieve treatment targets with first-line treatment because of poor efficacy or tolerability. However, comparative long-term adherence and switching data among patients initiating a second-line therapy after a first-line tumor necrosis factor inhibitor (TNFi) remain limited.</p> Methods <p>Retrospective data were from the Merative MarketScan<sup>®</sup> claims database, August 2018–October 2024. Eligible patients were aged ≥ 18&#xa0;years; diagnosed with RA; initiated upadacitinib (UPA), tofacitinib (TOF), adalimumab (ADA), etanercept (ETA), abatacept (ABA), or tocilizumab (TOC); and had discontinued a first-line TNFi within 12&#xa0;months prior to index. Treatment adherence and switching outcomes were reported at 1- and 3-year follow-up.</p> Results <p>Overall, 3782 and 1182 patients were included for the 1- and 3-year analyses, respectively. The proportion of patients with adherence ≥ 80% was highest with UPA at 1-year (49.5%) and 3-year follow-up (35.7%) versus other treatments. Compared with UPA through 3&#xa0;years, odds of being adherent were significantly lower for TOF (adjusted odds ratio [95% confidence interval]: 0.45 [0.29–0.71]), ADA (0.50 [0.33–0.75]), ETA (0.37 [0.24–0.58]), ABA (0.43 [0.26–0.73]), and TOC (0.46 [0.22–0.99]; <i>p</i> &lt; 0.05). Switch rates were lowest for UPA versus other treatments at 1&#xa0;year (28.6%) and remained lowest through 3&#xa0;years (47.6%), while rates for all other treatments increased to approximately 60%. Through 3&#xa0;years, patients were also significantly (<i>p</i> &lt; 0.05) more likely to switch treatment when receiving TOF (adjusted hazard ratios [95% confidence interval]: 1.40 [1.07–1.84]), ADA (1.44 [1.12–1.86]), ETA (1.57 [1.21–2.03]), ABA (1.56 [1.16–2.10]), and TOC (1.54 [1.03–2.32]) compared with UPA. Median 3-year time to switch was not reached for UPA and was 528–660&#xa0;days for all other treatments.</p> Conclusion <p>Among patients with RA who discontinued a first-line TNFi, second-line UPA was associated with significantly greater long-term adherence and lower switching rates than other advanced therapies.</p>

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Long-term Comparative Adherence and Switch Rates in Patients Receiving Advanced Therapies for Rheumatoid Arthritis After Use of One TNF Inhibitor

  • 期刊论文

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  • 发表日期：

    2026年7月14日

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  • Christina Charles-Schoeman,
  • Kurt Oelke,
  • Patrick M. Zueger,
  • Yi Peng,
  • Gregory Markley,
  • Richard Thielen,
  • Siran Fang,
  • Martin Bergman

摘要

Introduction

Patients with rheumatoid arthritis (RA) often fail to achieve treatment targets with first-line treatment because of poor efficacy or tolerability. However, comparative long-term adherence and switching data among patients initiating a second-line therapy after a first-line tumor necrosis factor inhibitor (TNFi) remain limited.

Methods

Retrospective data were from the Merative MarketScan® claims database, August 2018–October 2024. Eligible patients were aged ≥ 18 years; diagnosed with RA; initiated upadacitinib (UPA), tofacitinib (TOF), adalimumab (ADA), etanercept (ETA), abatacept (ABA), or tocilizumab (TOC); and had discontinued a first-line TNFi within 12 months prior to index. Treatment adherence and switching outcomes were reported at 1- and 3-year follow-up.

Results

Overall, 3782 and 1182 patients were included for the 1- and 3-year analyses, respectively. The proportion of patients with adherence ≥ 80% was highest with UPA at 1-year (49.5%) and 3-year follow-up (35.7%) versus other treatments. Compared with UPA through 3 years, odds of being adherent were significantly lower for TOF (adjusted odds ratio [95% confidence interval]: 0.45 [0.29–0.71]), ADA (0.50 [0.33–0.75]), ETA (0.37 [0.24–0.58]), ABA (0.43 [0.26–0.73]), and TOC (0.46 [0.22–0.99]; p < 0.05). Switch rates were lowest for UPA versus other treatments at 1 year (28.6%) and remained lowest through 3 years (47.6%), while rates for all other treatments increased to approximately 60%. Through 3 years, patients were also significantly (p < 0.05) more likely to switch treatment when receiving TOF (adjusted hazard ratios [95% confidence interval]: 1.40 [1.07–1.84]), ADA (1.44 [1.12–1.86]), ETA (1.57 [1.21–2.03]), ABA (1.56 [1.16–2.10]), and TOC (1.54 [1.03–2.32]) compared with UPA. Median 3-year time to switch was not reached for UPA and was 528–660 days for all other treatments.

Conclusion

Among patients with RA who discontinued a first-line TNFi, second-line UPA was associated with significantly greater long-term adherence and lower switching rates than other advanced therapies.