Newswise — WASHINGTON – According to research presented this week at the American College of Rheumatology Annual Meeting in Washington, D.C., prescribing anti-tumor necrosis factor drugs (also called anti-TNF) to treat rheumatoid arthritis may reduce the requirement for hospital admissions. The study also found that using anti-TNF therapy significantly reduced the need for hip and knee surgery procedures, resulting in more than $21 million in overall Irish health care cost savings.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, limitation of motion and loss of function of multiple joints. Though joints are the principal areas affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Medical conditions such as joint destruction and physical disability are outcomes of untreated rheumatoid arthritis. When prescribed alone to treat RA, traditional nonbiologic disease-modifying anti-rheumatic drugs (also called DMARDs) have proven to slow disease progression by nearly 20 percent. Anti-TNF therapies have been available in Ireland since 1999 and when combined with methotrexate for the appropriate patients, these drugs can eliminate all disease symptoms in up to 50 percent of patients with RA.

However, anti-TNF medications are expensive (the Irish average national cost in 2010 totaled $130 million) and the overall quality of life benefits when compared to total cost of using the drug, are often debated. To provide a better prospective about this debate, researchers from the St. Vincent's University Hospital in Dublin, Ireland, evaluated the number of hospital inpatient days and musculoskeletal surgical procedures nationally in RA patients treated with anti-TNF therapy (the estimated total RA population in Ireland is 40,000).

“Maintaining a patients’ functional ability through appropriate use of anti-TNF drugs may ultimately provide health care savings that surpass the cost of the drugs whilst conferring greater health upon the patient,” says Leonard C. Harty, co-investigator of the study from the department of rheumatology at St. Vincent's University Hospital in Dublin, Ireland.

The researchers reviewed hospital occupancy records from 1995 to 2010 using the national database, the Hospital In-Patient Enquiry system. Data from 57 hospitals with patients admitted with a diagnosis of RA were included. Age group, number of inpatient days, gender and reason for admission were also recorded. National annual prescription data from 2000 to 2010 for anti-TNF usage was separately analyzed. Total numbers and averages were calculated as well as the average percent change. The association between anti-TNF usage, patient admissions to hospital and medical procedures was examined.

The research team reviewed 57,774 inpatient records of RA patients (of which 66 percent were female and the average age was 66 years-old). The analysis found that annual anti-TNF prescriptions increased 156 percent per year from 2,389 units in 2000 to 116,747 in 2010. The increase in anti-TNF prescriptions matched a decrease in RA inpatient days, resulting in a 13 percent reduction in hospital admissions. Significant cost savings were recorded as a result of fewer hospital days. Additionally, the study found an overall 47 percent reduction in total musculoskeletal surgical procedures from 2002 to 2010.This decrease in total musculoskeletal surgical procedures was significantly associated with increased usage of anti-TNF in people with RA.

“There is no doubt that the advent of the biologic era has significantly improved health-related outcomes in patients with RA,” says Oliver FitzGerald, co-investigator of the study and professor at the Department of Rheumatology, St. Vincent's University Hospital in Dublin, Ireland.

The researchers note that additional factors other than anti-TNF therapy usage, such as improved use of non-biologic disease-modifying treatments and the prevention of other medical conditions, may have contributed to improved patient outcomes. Further analysis including the economic impact is currently underway.

Patients should talk to their rheumatologists to determine their best course of treatment.

The American College of Rheumatology is an international professional medical society that represents more than 9,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit or join the conversation on Twitter by using the official hashtag: #ACR2012.

Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover the ACR’s Simple Tasks campaign, which highlights the severity of rheumatic diseases and the importance of early and appropriate referral to a rheumatologist.

Editor’s Notes: Leonard C. Harty will present this research during the ACR Annual Meeting at the Walter E. Washington Convention Center at 4:45 PM on Tuesday, November 13 in Ballroom A. Oliver FitzGerald will be available for media questions and briefing at 8:30 AM on Monday, November 12 in the on-site press conference room, Room 203 A–B.

Presentation Number: 2540

Prescription of Tumour Necrosis Factor α Antagonists Is Strongly Associated with a Reduction in Hospital Admissions and in Musculoskeletal Surgical Procedures for Rheumatoid Arthritis Based On a 16 Year Analysis of Nationwide Data

Leonard C. Harty (Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland) Gary O'Toole (Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland)Kathleen Bennett ( Department of Pharmacology & Therapeutics, Trinity centre for Health Sciences, St James's Hospital, Dublin, Ireland) Oliver M. FitzGerald (Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland)

Background/Purpose: Comorbidities, joint destruction leading to orthopaedic intervention and physical disability are predictable outcomes of uncontrolled Rheumatoid Arthritis (RA). Synthetic DMARDS have a slow mechanism of action and used as monotherapy induce remission in <20% of RA patients. Tumour Necrosis Factor inhibitors (TNFi) were first prescribed in 1999, have a faster mechanism of action and in combination with methotrexate in early RA induce remission in up to 50%. It is argued that the clinical, functional and quality of life benefits of TNFi may not be sufficient to justify their significant economic cost (National expense, >€100 million/year in 2010). We thus sought to evaluate the number of hospital inpatient days and of musculoskeletal surgical procedures (MSKSPs) in RA patients from 1995 to 2010 and to assess whether there is any association with TNFi usage. Methods: The Hospital In-Patient Enquiry system (HIPE), which is a national system recording information on hospital bed utilization, was evaluated from 57 hospitals from 1995-2010 for patients admitted with a diagnosis of RA. Age group, number of inpatient days, gender and reason for admission (ICD codes) were also recorded. Annual prescription data for TNFi usage nationally was separately analysed from 2000 to 2010. Descriptive analyses are presented as totals, mean (standard deviation (SD)) and mean % change. Correlations were examined by Spearman’s rho; p<0.05 was considered statistically significant.

Results: 57,774 inpatient records in RA patients were reviewed from 1995-2010; F: M 2:1, mean age 66 (16). Annual TNFi prescribing has increased by 156% per annum (pa) from 2389 units in 2000 to 116,747 in 2010. An increase in TNFi prescribing coincided with a decrease in RA inpatient days for any reason: 49,000 (4880) pa pre-2002, reducing by 13% pa thereafter to 31000 pa in 2010 (r= -0.78, p=0.0055), likely contributing significantly to savings of approximately €16,000,000 pa based on current inpatient hospital costing. 550 (51) pa MSKSPs were recorded on RA in-patients pre-2002 with a subsequent reduction of 10% pa to 291 in 2010 (overall 47% decrease) and correlating significantly but negatively with number of TNFi prescriptions (r= -0.96, p<0.0001). 71 (27) pa elective hip procedures (64 replacements) were recorded pre-2002 with a subsequent reduction of 8% pa to 40 in 2010 (r= -0.88, p=0.0007), a 44% decrease on pre 2002. 79 (12) pa elective knee procedures (64 replacements) were recorded pre-2004 with a subsequent 7% pa reduction to 37 in 2010 (r= -0.96, p=0.003), a 53% decrease on pre-2004. Conclusion: Increased prescription of TNFi drugs for RA patients negatively correlates with reduction in RA hospital inpatient bed days and likely contributed significantly to estimated €16,000,000 pa savings. TNFi usage also correlates negatively with a reduction in all MSKSPs and specifically with both elective hip and knee procedures. It is recognised that factors other than TNFi usage, such as improved use of non-biologic disease-modifying treatments and prevention of comorbidities, may also have contributed to these improved patient outcomes. Further analysis of these data including the economic impact is underway.

Disclosure: Leonard C. Harty, NoneGary O'Toole, NoneKathleen Bennett, NoneOliver M. FitzGerald, Abbott Immunology Pharmaceuticals, Bristol-Myers Squibb, Abbott Immunology Pharmaceuticals, UCB, Abbott Immunology Pharmaceuticals.