RAPID3 disease activity trajectory among patients with rheumatoid arthritis new to specialty pharmacy medications.

Background: Understanding disease activity and therapy goals of patients with rheumatoid arthritis (RA) is important to provide patient-centered specialty pharmacy care and achieve positive therapy outcomes. The Routine Assessment of Patient Index Data 3 (RAPID3) is a validated metric to track patient-reported RA disease activity. Consistent and frequent monitoring of RAPID3 scores may provide clinically meaningful insights.

Objective: To describe the trajectory of RAPID3 scores over time and factors related to changes in RAPID3 scores among patients new to specialty medications.

Methods: Adult patients with RA who initiated specialty medications were included if they filled medications at least 3 times and had at least 2 RAPID3 scores documented in 6 months. Linear mixed effects regression models estimated trends in RAPID3 scores over time with respect to patient identifiers. Logistic regression models adjusted for baseline RAPID3 severity and estimated adjusted odds ratios (aOR) and associated 95% CIs of achieving a minimal clinically important improvement (≥3.8 points) or low severity/near remission (LS/NR) RAPID3 severity score at 6 months, by patient characteristics.

Results: Of 312 patients with RA, 195 (63%) had baseline high severity RAPID3 scores. Patients with baseline high severity achieved significant RAPID3 decreases over 6 months (5.9 points; P < 0.0001). Nearly half of patients (N = 147, 47%) had a clinically important improvement and 105 (34%) were LS/NR at follow-up; 67 patients (21%) met both criteria. After adjusting for baseline RAPID3 severity category, medication change (aOR, 0.39; 95% CI, 0.21-0.71) and opting out of full therapy management (aOR, 0.36; 95% CI, 0.19-0.65) were inversely associated with achieving a clinically important improvement. Being LS/NR at follow-up was also inversely associated with medication change (aOR, 0.19; 95% CI, 0.075-0.48) and opting out of full therapy management (aOR, 0.27; 95% CI, 0.12-0.63). Low medication adherence (aOR, 0.28; 95% CI, 0.11-0.72) and Medicaid insurance (aOR, 0.52; 95% CI, 0.29-0.93) were also inversely associated with being LS/NR at follow-up.

Conclusions: RAPID3 is a valuable tool in the specialty pharmacy setting, helping assess patient outcomes beyond traditional metrics. Specialty pharmacies should support their patients in striving to reach clinically important improvement and/or achieving LS/NR as measures of quality pharmacy care during the crucial months after therapy initiation and throughout care. Active collaboration between patients and pharmacists is crucial in reaching positive RA disease activity outcomes. To support this, implementing programs that foster patient engagement with pharmacists may be important for optimizing care delivery.