DMARDs mono-therapy in methotrexate intolerant rheumatoid arthritis patients
Disease Modifying Anti-rheumatic drugs (DMARDs) act not only by treating symptoms, but by altering the disease itself. They are not painkillers, but they reduce pain, swelling and stiffness over a period of weeks or months by slowing down the disease. Researchers believed that methotrexate is not a safe drug for treating rheumatoid arthritis, thus, other drugs were tested for alternative.
But, limited information is available on cost efficacy of the various biological agents for rheumatoid arthritis with intolerance or for whom it would be inappropriate to continue treatment with conventional agents. To estimate the efficacy and treatment costs of monotherapy, a clinical trial was conducted. Biological agents were used in the treatment of patients in the conducted trial.
Data were collected from two previous meta-analyses in treating patients who were intolerant to methotrexate (MTX) or among them it was inappropriate to continue the treatment with MTX. To estimate the respective cost for the number needed to treat (NNT) in the pharmacoeconomic comparison between biological agents, compared with placebo using both American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria. Four drugs i.e. adalimumab (ADA), etanercept (ETN), certolizumab pegol (CTZ) and tocilizumab (TCZ) were involved in the analysis. A period of 6 months was considered to understand the important differences in efficacy and treatment costs. Direct medical costs, including pharmacological therapy, administration and monitoring was also considered.
After the trial was completed using both ACR and EULAR criteria, results were evaluated indicating that TCZ (intravenous iv/subcutaneous sc) had lower NNT than the other agents. The difference in NNT observed for ETN was more pronounced with EULAR criteria, whereas when compared with ADA, the most sensitive differences observed were with criteria of ACR. Whereas, ETN had the lowest treatment cost followed by ADA, TCZ sc and TCZ iv. TCZ sc had the lowest cost for NNT with both ACR and EULAR criteria. The differences compared to ETN and ADA were significant and related with the level of efficacy. Sensitivity analysis were also confirmed with these results.
TCZ has proven to be a cost-effective therapeutic option than other tumor necrosis factor-α inhibitors (ADA, ETA, CTZ) as first line monotherapy for patients who were intolerant to MTX or for whom it was inappropriate to continue treatment with MTX.