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Initial Experience with Tofacitinib in Clinical Practice: Treatment Patterns and Costs of Tofacitinib Administered as Monotherapy or in Combination with Conventional Synthetic DMARDs in 2 US Health Care Claims Databases

Harnett et al. - Clin Ther. 2016 Mar 28. doi: 10.1116/j.clinthera. 2016.03.038 [Epub ahead of print]

This study analyzes data from two US claims databases between November 2012 and June 2014. It was designed to build upon knowledge from tofacitinib Phase 3 clinical trials providing clinical insights from independent sources on treatment patterns and costs for tofacitinib.

Data were collected from 337 patients in the Truven Marketscan (TM) and 118 patients in the Optum Clinformatics (OC) databases. In this early experience cohort for tofacitinib, approximately 75% of patients had previously received a biologic (two-thirds in the 12 months prior), which is in line with many treatment guidelines; more than half of the patients received monotherapy. Of those patients receiving combination therapy, most patients received methotrexate followed by leflunomide, hydroxyhloroquine or sulfasalazine.

RA-related medical costs in both databases decreased between the 12-month pre- and
post-treatment period. Overall treatment costs increased, possibly reflecting the increased prescription costs of tofacitinib compared with csDMARDs.

Dosing across the time was consistent at 5mg bid for over 98% of patients. Adherence levels were similar to those seen in patients taking TNFis, while adherence and persistence were similar whether patients received monotherapy or combination therapy.

While any claims database has clear limitations, this paper provides an interesting initial insight into the usage, adherence and costs of using tofacitinib in the US.