Patient support programs reduce opioid use in patients with autoimmune diseases

Patient Support Programs (PSP), particularly adalimumab (ADA) PSP, have been able to reduce opioid use and increase medication adherence in patients with rheumatic diseases, according to a study published in Springer.1

Although opioids are not a recommended treatment for patients with autoimmune diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), many patients use them regularly. ADA, a tumor necrosis factor inhibitor (anti-TNF), is a safe and effective treatment for these diseases. This, along with PSPs designed to help patients manage their treatments, may help reduce opioid use in this patient population, thereby reducing the risk of misuse, abuse, and mortality.

“The prevalence of opioid use is high in the general population and even higher in patients with autoimmune diseases, although opioid pain relievers are not a recommended treatment for these patients,” the researchers said. “Given the reported risks associated with opioid use, it is essential to help patients reduce their risk of prolonged use.”

The study used real-world claims data from the Symphony Health Solutions (SHS) database between January 2006 and October 2018. The data included medical and pharmaceutical claims, which covered over 280 million people and a variety of of payers. The PSP analyzed was HUMIRA Complete, which used ADA therapy and assisted patients with financial assistance, product training, medication recalls, a sharps container for pen and syringe disposal, a injection, transport and support training through a nurse ambassador program.

Eligible patients were ≥ 18 years of age, commercially insured and initiated ADA treatment between January 2015 and October 2018. They were then placed in 2 cohorts: PSP and non PSP. PSP patients registered with PSP within 30 days of the index date and used the Nurse Ambassador program.

ADA adherence, which includes proportion of days covered (PDC) and persistence, opioid initiation, 2+ opioids, and opioid supply were compared between the 2 groups. The results were checked for the characteristics of the patients.

A total of 1952 patients were enrolled in the PSP cohort and 728 were enrolled in the non-PSP cohort. Patients in the PSP cohort reported better ADA adherence over the 12-month follow-up, including higher PDC (62.5% vs. 46.9%, adjusted p

The study was limited by the differences between the PSP and non-PSP cohorts, as patients could choose whether or not to participate. However, the study mitigates the impact by comparing patient characteristics in statistical analyzes. It also focused on patients who were not dependent on opioids, so the results may not be the same as those in other patient populations or PSPs. In addition, patients with government-provided insurance were not eligible for PSP services.

“We are finding that PSP participation is associated with increased ADA adherence, lower rates of opioid initiation and, among those who have started, lower opioid use,” the investigators concluded. “While more research is needed to understand the specific mechanisms behind these findings, it highlights the potential benefits of improved drug-taking behavior and better disease control that can be induced by PSP involvement.

Reference:

Fendrick AM, Macaulay D, Goldschmidt D et al. Better medication adherence and lower opioid use in people with autoimmune disease enrolled in an Adalimumab patient support program in the United States [published online ahead of print, 2021 Apr 25]. Rheumatol Ther. 2021; 10.1007 / s40744-021-00309-9. doi: 10.1007 / s40744-021-00309-9


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