Nearly half of people with rheumatoid arthritis (RA) who take the costly drug tofacitinib (Xeljanz), stop taking it altogether after a year, and about one-third stop taking it after only six months.
Pharmacy benefits manager, Prime Therapeutics, learned this after conducting a large analysis of its commercially insured members, and they want to know why.
“This discontinuation rate is concerning, especially since RA is a chronic disease generally requiring life-long therapy,” the company stated in an announcement.
The study analyzed 4.4 million insured people who were continuously enrolled over a 4-year period – from December 2012 to December 2015. A total of 887 used Xeljanz during that time frame, and 97.2 percent of them had medical claims related to an RA diagnosis. It found that 44 percent of RA patients taking Xeljanz had discontinued the drug at one year after starting therapy.
On average, use of Xeljanz increased steadily by 10.5 members per month throughout the analysis period.
“Although utilization of Xeljanz is low, it is steadily increasing,” said Pat Gleason, PharmD, director of health outcomes at Prime. “With a lack of long-term safety and efficacy information and a wholesale acquisition cost (WAC) of over $42,000 per year, it is critical to understand real world Xeljanz utilization patterns to best manage the health of our members with rheumatoid arthritis.”
Xeljanz is identified in the American College of Rheumatology Guidelines as a second line therapy option in patients with RA. However, “one in 10 members were using it as first line therapy and did not have a disease-modifying anti-rheumatic drug (DMARD) claim in the year prior to Xeljanz therapy, in accordance with the guidelines.”
“Prime’s research on utilization and adherence patterns of the rheumatoid arthritis drug Xeljanz shows there is opportunity for improvement,” added Gleason. “Care and utilization management programs, as well as outcomes-based contracts with pharmaceutical manufacturers, that encourage adherence and the most cost effective treatment strategies, should be considered. These programs should emphasize the use of a nonbiologic DMARD as first line therapy.”