Patient Characteristics and Indicators of Treatment Initiation with Repository Corticotropin Injection in Patients with Rheumatoid Arthritis: A Claims Database Analysis.
Abstract
Repository corticotropin injection (RCI) is indicated as adjunctive, short-term therapy
in selected patients with RA. To characterize RCI users and identify predictors of
RCI initiation in RA, we compared preindex characteristics, treatment patterns, comorbidities,
healthcare resource utilization (HCRU), and costs for patients who had initiated RCI
treatment (RCI cohort) versus patients with no RCI claims and ≥ 1 targeted synthetic
or biologic disease-modifying antirheumatic drugs (ts/bDMARD) claim (non-RCI ts/bDMARD
cohort). We analyzed pharmacy and medical claims data from a large commercial and
Medicare supplemental administrative database. Inclusion criteria were age ≥ 18 years, ≥ 1
inpatient or ≥ 2 outpatient claims with RA diagnosis (January 1, 2007-December 31,
2018), and 12-month continuous medical and pharmacy coverage preindex. Results from
baseline cohort comparisons informed multiple logistic regression analysis. Compared
with the non-RCI ts/bDMARD cohort (n = 162,065), the RCI cohort (n = 350) had a greater
proportion of patients with higher Charlson comorbidity index (CCI) scores; higher
mean claims-based index of RA severity and CCI scores; greater frequency of almost
all comorbidities; higher use of nontraditional DMARDs, glucocorticoids, and opioids;
higher all-cause HCRU; and higher medical and total costs. By multivariable analysis,
the most significant predictors of RCI initiation were intermittent glucocorticoid
use at any dose (odds ratio [OR] 1.67), extended-use glucocorticoids at medium (OR
2.03) and high doses (OR 2.99), nontraditional DMARD use (OR 2.09), anemia (OR 1.39),
and renal disease (OR 2.45). Before RCI initiation, patients had more severe RA, higher
comorbidity burden, greater use of glucocorticoids and opioids, and higher HCRU compared
with non-RCI initiators. The most significant predictors for starting RCI in patients
with RA were intermittent use of glucocorticoids at any dose, extended-use high-dose
glucocorticoids, use of nontraditional DMARDs, and comorbid anemia and renal disease.
Type
Journal articleSubject
ACTHActhar® Gel
Glucocorticoids
Healthcare utilization
RCI
Repository corticotropin injection
Rheumatoid arthritis
Permalink
https://hdl.handle.net/10161/26281Published Version (Please cite this version)
10.1007/s40744-020-00272-xPublication Info
Hayes, Kyle; Panaccio, Mary P; Goel, Niti; & Fahim, Mohammed (2021). Patient Characteristics and Indicators of Treatment Initiation with Repository Corticotropin
Injection in Patients with Rheumatoid Arthritis: A Claims Database Analysis. Rheumatology and therapy, 8(1). pp. 327-346. 10.1007/s40744-020-00272-x. Retrieved from https://hdl.handle.net/10161/26281.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Niti Goel
Adjunct Assistant Professor in the Department of Medicine

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info