Long-term etanercept retention patterns and factors associated with treatment discontinuation: a retrospective cohort study using Canadian claims-level data
To examine 12-month retention rates over 6 years of etanercept patients in Canada, and to identify factors associated with treatment discontinuation. A retrospective cohort study was conducted using longitudinal prescription drug claims data from IQVIA Private Drug Plan database (PDP), Ontario Public Drug Plan database (OPDP), and Régie de l’assurance maladie du Québec database (RAMQ). Between 07/2008 and 06/2010, bio-naïve patients who initiated etanercept were identified and followed for 72 months. Twelve-month retention rates were estimated in one-year increments and factors associated with time to discontinuation over the 72-month period were identified using a Cox proportional hazards regression model. The study identified 4528 etanercept patients (61% female, 85% rheumatic diseases, and 15% psoriasis). Twelve-month etanercept retention rates increased significantly for patients following their first year on therapy (p < 0.0001), with 66% of patients retained at year 1 vs. 79, 82, 84, 83, and 79% at years 2, 3, 4, 5, and 6, respectively. 17.1% (n = 771) of patients were retained for the entire 72-month study. Patients with psoriasis were at increased risk (HR 1.199; p < 0.0001); while public drug coverage plan patients (OPDP HR 0.721; p < 0.0001 and RAMQ HR 0.537; p < 0.0001) were at decreased risk of treatment discontinuation. Twelve-month etanercept retention rates increased significantly for patients following their first year on therapy. Indication and drug coverage plan were associated with patients’ time to etanercept discontinuation. With a better understanding of factors associated with retention, programs can be designed to address the specific needs of at-risk groups while supporting patients stable on therapy.
KeywordsAnkylosing spondylitis Epidemiology Psoriasis Psoriatic arthritis Rheumatoid arthritis
All authors made substantial contributions to the conception, design, acquisition, analysis, and interpretation of data, and drafting of the work and revising it critically for intellectual content. All authors contributed to the development of the publication and maintained control over the final content.
Financial support for the study was provided by Pfizer. Pfizer participated in the design of the study, interpretation of data, review, and approval of this publication.
Compliance with ethical standards
Conflict of interest
Dr. Majed Khraishi is an advisor for Pfizer and Amgen. Dr. Jelena Ivanovic, Yvonne Zhang, Marie-Josee Brabant, Dr. Katia Charland, and Brad Millson are employees of QuintilesIMS and have collaborated on this study in connection with the development of this manuscript as paid consultants to Pfizer. Dr. John Woolcott and Heather Jones are employees of Pfizer.
- 2.Spector TD (1990) Rheumatoid arthritis. Rheum Dis Clin N Am 16(3):513–537Google Scholar
- 4.Jacobs P, Bissonnette R, Guenther L (2011) Socioeconomic burden of immune-mediated inflammatory diseases—focusing on work productivity and disability. J Rheumatol 88:55–61Google Scholar
- 8.Mohler KM et al (1993) Soluble tumor necrosis factor (TNF) receptors are effective therapeutic agents in lethal endotoxemia and function simultaneously as both TNF carriers and TNF antagonists. J Immunol (Baltimore, Md: 1950) 151(3):1548–1561Google Scholar
- 12.Kristensen LE, Kapetanovic MC, Gülfe A, Söderlin M, Saxne T, Geborek P (2008) Predictors of response to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA: results from the South Swedish Arthritis Treatment Group Register. Rheumatology (Oxford) 47(4):495–499CrossRefGoogle Scholar
- 13.Hetland ML, Christensen IJ, Tarp U, Dreyer L, Hansen A, Hansen IT, Kollerup G, Linde L, Lindegaard HM, Poulsen UE, Schlemmer A (2010) Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry. Arthritis Rheumatol 62(1):22–32CrossRefGoogle Scholar
- 17.Frazier-Mironer A, Dougados M, Mariette X, Cantagrel A, Deschamps V, Flipo RM, Logeart I, Schaeverbeke T, Sibilia J, le Loët X, Combe B (2014) Retention rates of adalimumab, etanercept and infliximab as first and second-line biotherapy in patients with rheumatoid arthritis in daily practice. Joint Bone Spine 81(4):352–359CrossRefPubMedGoogle Scholar
- 18.Heiberg MS, Koldingsnes W, Mikkelsen K, Rødevand E, Kaufmann C, Mowinckel P, Kvien TK (2008) The comparative one-year performance of anti–tumor necrosis factor α drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Care Res 59(2):234–240CrossRefGoogle Scholar
- 20.Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG (2013) Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the national psoriasis foundation surveys, 2003-2011. JAMA Dermatol 149(10):1180–1185CrossRefPubMedGoogle Scholar
- 21.Dixon J (2014) Pharmacare in Canada. In: Conference Backgrounder. The Monieson Centre For Business Research in Healthcare. Queen’s School of Business. http://www.moniesonhealth.com/resources/2014-WhitePaper-Dixon.pdf (Date of Access: October 1, 2017)
- 24.Lie E, Kristensen LE, Forsblad-d'Elia H, Zverkova-Sandström T, Askling J, Jacobsson LT, for the ARTIS Study Group (2015) The effect of comedication with conventional synthetic disease modifying antirheumatic drugs on TNF inhibitor drug survival in patients with ankylosing spondylitis and undifferentiated spondyloarthritis: results from a nationwide prospective study. Ann Rheum Dis 74(6):970–978CrossRefPubMedGoogle Scholar