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

Samantha Alvarez-Madrazo, Kimberley Kavanagh, Stefan Siebert, Yvonne Semple, Brian Godman, Alessandra Maciel Almeida, Francisco de Assis Acurcio, Marion Bennie

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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.
Original languageEnglish
Article numbere027059
Number of pages11
JournalBMJ Open
Issue number9
Publication statusPublished - 4 Sep 2019


  • biologics
  • psoriatic arthritis
  • rheumatoid arthritis
  • ankylosing spondylitis
  • persistence
  • adherence

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