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Clinical Utility and Cost Savings in Predicting Inadequate Response to Anti-TNF Therapies in Rheumatoid Arthritis

Author

Rheumatol Ther. 2020 Aug 14. doi: 10.1007/s40744-020-00226-3. Online ahead of print.

Martin J Bergman 1, Alan J Kivitz 2, Dimitrios A Pappas 3 4, Joel M Kremer 5, Lixia Zhang 6, Anna Jeter 6, Johanna B Withers 7

Author Information

1 Drexel University College of Medicine, Philadelphia, PA, USA.

2 Department of Rheumatology, Altoona Center for Clinical Research, Duncansville, PA, USA.

3 Columbia University, New York, NY, 10027, USA.

4 CORRONA, LCC, Waltham, MA, USA.

5 The Center for Rheumatology, Albany Medical College, Albany, NY, USA.

6 Scipher Medicine Corporation, 221 Crescent St., Suite 103A, Waltham, MA, USA.

7 Scipher Medicine Corporation, 221 Crescent St., Suite 103A, Waltham, MA, USA. johanna.withers@sciphermedicine.com.

Abstract

Introduction: The PrismRA® test identifies rheumatoid arthritis (RA) patients who are unlikely to respond to anti-tumor necrosis factor (anti-TNF) therapies. This study evaluated the clinical and financial outcomes of incorporating PrismRA into routine clinical care of RA patients.

Methods: A decision-analytic model was created to evaluate clinical and economic outcomes in the 12-month period following first biologic treatment. Two treatment strategies were compared: (1) observed clinical decision-making based on a 175-patient cohort receiving an anti-TNF therapy as their first biologic after failure of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and (2) modeled clinical decision-making of the same population using PrismRA results to inform first-line biologic treatment choice. Modeled costs include biologic drug pharmacy, non-biologic pharmacy, and total medical costs. The odds of inadequate response to anti-TNF therapies and various components of patient care were calculated based on PrismRA results.

Results: Identifying predicted inadequate responders to anti-TNF therapies resulted in a modeled 38% increase in ACR50 response to first-line biologic therapies. The fraction of patients who achieved an ACR50 response to any therapy (TNFi and others) within the 12-month period was 33% higher in the PrismRA-stratified population than in the unstratified population (59 vs. 44%, respectively). When therapy prescriptions were modeled according to PrismRA results, cost savings were modeled for all financial variables: overall costs (4% decreased total, 19% decreased on ineffective treatments), total biologic drug pharmacy (4% total, 23% ineffective), non-biologic pharmacy (2% total, 19% ineffective), and medical costs (6% total, 19% ineffective). Female sex was the clinical metric that showed the greatest association with inadequate response to anti-TNF therapies (odds ratio 2.42, 95% confidence interval 1.20, 4.88).

Conclusions: If PrismRA is implemented into routine clinical care as modeled, predicting which RA patients will have an inadequate response to anti-TNF therapies could save > $7 million in overall ineffective healthcare costs per 1000 patients tested and increase targeted DMARD response rates in RA.