Outcomes of Tumor Necrosis Factor Inhibitor Cycling versus Switching to a Disease-modifying Anti-rheumatic Drug with a New Mechanism of Action Among Patients with Rheumatoid Arthritis

J Med Econ 2017;20:464–73

This retrospective study looked at claims-based datasets to establish whether it is preferable to switch to another TNF inhibitor (TNFi) or to a therapy with a different mechanism of action (MOA) when RA treatment failure occurs with an initial TNFi, due to inadequate response or lack of tolerability.Administrative claims data from a large US database were used to compare treatment patterns, treatment effectiveness (based on fulfillment of six criteria) and costs in in the 12 months after RA patients switched from one TNFi to another (n=935) or to an alternative MOA drug (n=581). New MOA switchers were 39% more likely than TNFi cyclers to persist with the new treatment and 36% less likely to switch again, as well as 43% more likely to be treated effectively. Drug costs were 16% lower and total RA-related healthcare costs 11% lower in patients who switched to a new MOA than in those who cycled to another TNFi.These results support switching to a new MOA after treatment with a TNF fails, which is consistent with recent guidelines for the pharmacologic management of established RA.