Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study

Objectives: to understand patterns of subcutaneous (SC) biologic use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design: retrospective cohort Setting: patients in secondary care receiving SC biologics in the largest Scottish Health Board Participants: a new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 - May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. Outcomes measured: a standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and Compliance Rate (CR). Results: 751 patients were identified (AS – 105, PsA – 227, RA - 419) of whom 89.3% had more than one biologic delivery (median days’ follow-up: AS - 494; PsA – 544; RA - 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority re-initiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA - AS 84.0%, PsA 85.0%, RA 82.4%) or CR (median %CR - AS 96.6%, PsA 97%, RA 96.6%). Conclusion: Use of linked routine data is a sustainable pathway to enable on-going evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.