“Persistence is really the sustainability of a medication and it is essential for a successful therapy”, explains Douglas Veale, St Vincent’s Hospital, Dublin (Ireland). From 100% prescriptions, only 88% are filled, 76% are taken and even less are continued. A trial looked at the 10 block buster medications and came to the following conclusion: for every person, where a drug helps, there are between 3 and 24 people where it will not be effective. “TNF-blockers are not too bad compared to other drugs, but even they help only one in four people”, says Veale. The reason might be that some patients take their medication irregularly: Therefore, in a direct comparison of adherence (which used to be called compliance) and persistence, adherence is always lower than persistence due to poor execution of dosing regimen.
Persistence is particularly difficult, if patients are in remission. “In my practise I see many patients who want to stop therapy, when they feel good”, says Veale. But trials suggest that very few patients can stop and stay well, most of them will relapse. Data from switching one TNF-blocker to a second show, that there are a lot more patients that show secondary non-response compared to primary non-response. The reason for the secondary non-response could also be non-persistence.
Clinical trials with golimumab where performed in different rheumatic diseases (psoriatic arthritis, rheumatoid arthritis, spondyloarthritis) and in different patient situations (TNF-blocker naïve patients, Methotrexate (MTX) naïve patients, MTX inadequate responders): “No matter in what indication or patient group, golimumab showed an impressive persistence rate of nearly 70%”, said Veale. Persistence rates seen with other TNF blockers in RA long-term extensions studies were between 52 and 55%.
In his view, the most important reason why patients stay on therapy is, that the drug is working. This is also an explanation for the good persistence seen with golimumab: A couple of trials showed that clinical efficacy through 5 years is maintained, when golimumab is given as first-line biologic therapy. High persistence rates could also be shown in a real-world setting: Real-world data from a Swedish registry shows higher persistence rates for Golimumab compared to other TNF-blockers.
Another trial from the US took late refills of medication as a surrogate parameter for low persistence. In this trial, golimumab was also superior to other TNF-blockers.
Side effects can have a detrimental effect on persistence. “With golimumab, injection side reactions are very low and present only in up to 0.8% of patients”, says Veale.
Last but not least, the time a physician spends on the first prescription of a TNF-blocker is crucial for the persistence. “We should keep this in mind, as persistence represents long-term success of a treatment”, concluded Veale.
Source: Veale D. How are biologic therapies performing on persistence rate?, Symposium “Persistence on therapy: a key factor in the successful management of rheumatic disease”, presented on the 9th of June.
Author Dr. Susanne Kammerer. All rights reserved by Medicom
Source: 2016 Annual EULAR Meeting