Uptake and Clinical Utility of Multibiomarker Disease Activity Testing in the United States

J Rheumatol. 2019 Mar;46(3):237-244. doi: 10.3899/jrheum.180071. Epub 2018 Nov 15.

Abstract

Objective: The clinical utility of the multibiomarker disease activity (MBDA) test for rheumatoid arthritis (RA) management in routine care in the United States has not been thoroughly studied.

Methods: Using 2011-2015 Medicare data, we linked each patient with RA to their MBDA test result. Initiation of a biologic or Janus kinase (JAK) inhibitor in the 6 months following MBDA testing was described. Multivariable adjustment evaluated the likelihood of adding or switching biologic/JAK inhibitor, controlling for potential confounders. For patients with high MBDA scores who added a new RA therapy and were subsequently retested, lack of improvement in the MBDA score was evaluated as a predictor of future RA medication failure, defined by the necessity to change RA medications again.

Results: Among 60,596 RA patients with MBDA testing, the proportion adding or switching biologics/JAK inhibitor among those not already taking a biologic/JAK inhibitor was 9.0% (low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Similarly, among those already taking biologics/JAK inhibitor, the proportions were 5.2%, 8.3%, and 13.5% (p < 0.0001). After multivariable adjustment, referent to those with low disease MBDA scores, the likelihood of switching was 1.51-fold greater (95% CI 1.35-1.69) for patients with moderate MBDA scores, and 2.62 (2.26-3.05) for patients with high MBDA scores. Among those with high MBDA scores who subsequently added a biologic/JAK inhibitor and were retested, lack of improvement in the MBDA score category was associated with likelihood of future RA treatment failure (OR 1.61, 95% CI 1.27-2.03).

Conclusion: The MBDA score was associated with both biologic and JAK inhibitor medication addition/switching and subsequent treatment outcomes.

Keywords: BIOLOGICS; BIOMARKER; MEDICATION PERSISTENCE; MEDICATION SWITCHING; RHEUMATOID ARTHRITIS.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / diagnosis*
  • Arthritis, Rheumatoid / drug therapy*
  • Biological Products / therapeutic use*
  • Biomarkers
  • Diagnostic Tests, Routine / methods*
  • Drug Substitution
  • Female
  • Follow-Up Studies
  • Humans
  • Janus Kinase Inhibitors / therapeutic use*
  • Male
  • Medicare
  • Middle Aged
  • Severity of Illness Index*
  • Treatment Outcome
  • United States

Substances

  • Antirheumatic Agents
  • Biological Products
  • Biomarkers
  • Janus Kinase Inhibitors