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Péntek M, Lakatos PL, Oorsprong T, Gulácsi L, Pavlova M, Groot W, Rencz F, Brodszky V, Baji P, Crohn’s Disease Research Group. Access to biologicals in Crohn’s disease in ten European countries. World J Gastroenterol 2017; 23:6294-6305. [PMID: 28974896 PMCID: PMC5603496 DOI: 10.3748/wjg.v23.i34.6294] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze access (availability, affordability and acceptability) to biologicals for Crohn’s disease (CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic development.
METHODS A questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, Latvia, Poland, Romania, Slovakia, Spain and Sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product (GDP) per capita. Correlations with the uptake of biologicals, dimensions of access and GDP per capita were calculated.
RESULTS At the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries (France, Germany, Latvia, Slovakia, Sweden). Reimbursement criteria were the least strict in Sweden and Germany, and the strictest in Hungary, Poland and Slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in Sweden (13%-37% of the GDP per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary (87%-124%) and Romania (141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDP per capita (0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with CD on biologicals per 100000 population and the availability and affordability was also strong (-0.75, -0.69 respectively).
CONCLUSION Substantial inequalities in access to biologicals were largely associated with GDP. To explain differences in access among countries with similar development needs further research on acceptance.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary
| | - Peter L Lakatos
- McGill University, MUHC, Montreal General Hospital, H3G 1A4 Montreal, Canada
- 1st Department of Internal Medicine, Semmelweis University, H-1083 Budapest, Hungary
| | - Talitha Oorsprong
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 GT Maastricht, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 GT Maastricht, The Netherlands
- Top Institute Evidence Based Education Research (TIER), Teachers Academy, Maastricht University, 6211 KH Maastricht, The Netherlands
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary
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Hifinger M, Hiligsmann M, Ramiro S, Watson V, Berghea F, Péntek M, Keat A, Severens JL, Fautrel B, Boonen A. Influence of disease activity on RA treatment choices in countries with restricted access to expensive, innovative drugs: a discrete choice experiment among rheumatologists. RMD Open 2017; 3:e000453. [PMID: 28912960 PMCID: PMC5588932 DOI: 10.1136/rmdopen-2017-000453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/13/2017] [Accepted: 06/28/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the influence of disease activity of patients with rheumatoid arthritis on treatment choices of rheumatologists in countries with restricted access to expensive, innovative drugs. Methods Rheumatologists from Hungary, Romania and UK were invited to complete two consecutive discrete choice experiments with hypothetical drug treatments for two different patient profiles: high and moderate disease activity. Rheumatologists were asked to choose repeatedly between two unlabelled treatment options that differed in five attributes: efficacy (expected improvement and achieved disease activity state), safety (probability of serious adverse events), patient's preference (level of agreement), total medication costs and cost-effectiveness. A heteroscedastic discrete choice model using interaction terms between attribute levels and patient profiles (binary variable) was used to assess the preferences of rheumatologists towards each attribute and the influence of the patient profile. Results Overall, 148 rheumatologists completed the survey (46% females, mean age 49 years, 49% academic). For both patient profiles, efficacy dominated the treatment choice over patient's preference, safety and economic aspects. However, for patients with high compared with moderate disease activity, the importance of drug efficacy significantly increased (from 48% for moderate to 57% for high disease activity), whereas the importance of patient's preference significantly decreased (from 15% to 11%). No significant differences were observed for economic and safety considerations. Conclusion Rheumatologists were willing to give up some efficacy to account for patient's preference when choosing treatments for patients with moderate compared to high disease activity. Disease activity however did not influence importance of economic aspects in treatment choices.
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Affiliation(s)
- Monika Hifinger
- CAPHRI Research Institute,Maastricht University, Maastricht, The Netherlands.,Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mickael Hiligsmann
- CAPHRI Research Institute,Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Verity Watson
- Health Economics Research Unit,University of Aberdeen, Aberdeen, UK
| | - Florian Berghea
- Department of Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Márta Péntek
- Department of Health Econmics, Corvinus University of Budapest, Budapest, Hungary.,Department of Rheumatology, Flór Ferenc Hospital, Kistarcsa, Hungary
| | - Andrew Keat
- Arthritis Centre,Northwick Park Hospital, Harrow, UK
| | - Johan L Severens
- Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam, The Netherlands
| | - Bruno Fautrel
- Department of Rheumatology, Pierre et Marie Curie University, Paris, France
| | - Annelies Boonen
- CAPHRI Research Institute,Maastricht University, Maastricht, The Netherlands.,Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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53
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Uhlig T, Goll GL. Reviewing the evidence for biosimilars: key insights, lessons learned and future horizons. Rheumatology (Oxford) 2017; 56:iv49-iv62. [PMID: 28903542 PMCID: PMC5850213 DOI: 10.1093/rheumatology/kex276] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/12/2017] [Indexed: 12/28/2022] Open
Abstract
Biologic therapies have become central to the long-term management of many chronic diseases, including inflammatory rheumatic diseases. Over recent years, the development and licensing pathways for biosimilars have become more standardized, and several biosimilars have been made available for patients with inflammatory rheumatic diseases, such as RA. Pre-licensing requirements for biosimilars mandate the demonstration of comparability with reference products in terms of clinical activity, safety and immunogenicity, whereas post-marketing surveillance and risk minimization requirements are set in place to ensure that long-term, real-world safety data are collected to assess biosimilars in clinical practice. These measures should provide a foundation for physician confidence in biosimilars, which can be established further through clinical experience. Biosimilars may help to fill an unmet need by improving patient access to effective biologic treatments for chronic diseases. Greater access may result in additional clinical benefits, with appropriate use of biologic therapies according to treatment guidelines being associated with improved outcomes and the potential for reduced costs of care. Key challenges for the integration of biosimilars into everyday practice include questions about interchangeability, switching and automatic substitution. Several switching studies have shown that biosimilars can be used in place of reference products while maintaining efficacy and safety. Additional ongoing studies and registries may help to optimize the process of switching, and different funding models are examining the optimal mechanisms to ensure effective uptake of these new treatments.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology
| | - Guro L. Goll
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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54
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Kaló Z, Vokó Z, Östör A, Clifton-Brown E, Vasilescu R, Battersby A, Gibson E. Patient access to reimbursed biological disease-modifying antirheumatic drugs in the European region. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1345580. [PMID: 28740623 PMCID: PMC5508389 DOI: 10.1080/20016689.2017.1345580] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
Background & Objectives: Biological disease-modifying antirheumatic drugs (bDMARDs) for the treatment of rheumatoid arthritis (RA) are not always accessible to all patients in accordance with international guidelines, partly owing to their high direct costs against a background of restricted healthcare budgets. This study compares the size of RA patient populations with access to reimbursed bDMARDs across 37 European countries, Russia, and Turkey, according to their treatment eligibility defined by European League Against Rheumatism (EULAR) recommendations and national reimbursement criteria. Methods: The size of the RA patient population eligible for bDMARD treatment was estimated in a population model using published RA epidemiological data and clinical criteria defined by 2013 EULAR recommendations along with national reimbursement criteria defined in a survey of the 39 countries in November 2015. Results: According to EULAR recommendations, 32% of the total RA population in the European region is eligible for bDMARD treatment. However, only an average 59% of this EULAR-eligible population remains eligible after applying national reimbursement criteria (from 86% in 'high access' to 13% in 'low-access' countries). Conclusion: Access to reimbursed bDMARDs remains unequal in the European region. As biosimilars of bDMARDs are introduced, changes in reimbursement criteria may increase access to bDMARDs and reduce this inequality.
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Affiliation(s)
- Zoltán Kaló
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Vokó
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Andrew Östör
- Rheumatology Clinical Research Unit, Addenbrookes Hospital, Cambridge, UK
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55
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Yoo DH. CT-P13 in the treatment of rheumatoid arthritis. Expert Rev Clin Immunol 2017; 13:653-666. [PMID: 28571501 DOI: 10.1080/1744666x.2017.1337510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The first biosimilar infliximab, CT-P13 infliximab-dyyb was approved in 2013 by the European Medicines Agency (EMA) and in 2016 by the United States Food and Drug Administration (FDA) and has been used for the treatment of rheumatoid arthritis (RA) for 4 years. Areas covered: CT-P13 with the three brand names on the market has highly similar efficacy and safety profiles but lower price than originator infliximab and are approved in more than 80 countries. One of the most important determinants of the implementation of CT-P13 in the treatment of RA is scientific evidence from clinical studies and real-world pharmacovigilance data. Here, we review all available clinical data supporting the similarity of CT-P13 to originator infliximab in its clinical efficacy and safety for the treatment of RA and related arthritis. In addition, we consider the role of CT-P13 in therapeutic strategies for RA treatment. Expert commentary: With its highly similar efficacy and safety profile to originator infliximab and its lower price, CT-P13 is expected to be very useful in RA treatment, whether it is applied earlier or switched from originator infliximab or other biologics. Future educational initiatives will be important to overcome misunderstandings about biosimilars and to improve the implementation of CT-P13.
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Affiliation(s)
- Dae Hyun Yoo
- a Hanyang University Hospital for Rheumatic Diseases, College of Medicine , Hanyang University , Seoul , Republic of Korea
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56
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Sullivan E, Piercy J, Waller J, Black CM, Kachroo S. Assessing gastroenterologist and patient acceptance of biosimilars in ulcerative colitis and Crohn's disease across Germany. PLoS One 2017; 12:e0175826. [PMID: 28410403 PMCID: PMC5391967 DOI: 10.1371/journal.pone.0175826] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/01/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study examined gastroenterologists' motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behaviour, and explored patient attitudes to biosimilars. METHODS Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken in 2015-2016 with German gastroenterologists and patients with ulcerative colitis or Crohn's disease. Gastroenterologists provided data on their prescribing behaviour and attitudes towards biosimilars, and invited the next eight eligible consecutive consulting patients to complete a detailed questionnaire. For analysis, gastroenterologists were split into 'Investigative', 'Conservative', and 'Other' groups. RESULTS Overall, 25 gastroenterologists and 136 patients participated. Biosimilars accounted for <15% of all biologic therapies and >80% of gastroenterologists would prescribe a bio-originator rather than biosimilar as 1st line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, although of those receiving biosimilars, 79% were satisfied with the current treatment of their condition, and 69% were satisfied with the control of symptoms. Although at least 35% of patients in each analysis group reported no concerns when starting treatment with a bio-originator or biosimilar, 41% of previously biologic-naïve patients prescribed a biosimilar indicated potential side effects and potential long-term problems, and 24% not knowing enough about the drug, as concerns. CONCLUSION Results demonstrate that there is reluctance from patients to accept biosimilars and the need to further educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and physician communication. There remains a need for further research into non-clinical switching and the long term impact of prescribing biosimilars.
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Affiliation(s)
| | | | - John Waller
- Adelphi Real World, Manchester, United Kingdom
| | | | - Sumesh Kachroo
- Merck & Co., Inc., Kenilworth, NJ, United States of America
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57
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Update on biosimilars in rheumatology. Inflammopharmacology 2017; 25:177-184. [PMID: 28265837 DOI: 10.1007/s10787-017-0333-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Biologic agents have become indispensable in the management of autoimmune disease particularly rheumatological conditions. The lives of countless individuals have been improved following treatment with these drugs. Unfortunately, their cost prohibits more widespread use around the globe. This critical issue has been addressed by the introduction of biosimilars into the market. These therapies have been developed to resemble the originator molecule as closely as possible and to increase competition in the therapy area thus allowing costs to be reduced. Our review is intended to offer an update on biosimilars including logistic considerations on their introduction into routine practice.
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58
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Sung YK, Cho SK, Kim D, Won S, Choi CB, Bang SY, Hong SJ, Kim HA, Koh EM, Lee HS, Suh CH, Yoo DH, Bae SC. Characteristics and outcomes of rheumatoid arthritis patients who started biosimilar infliximab. Rheumatol Int 2017; 37:1007-1014. [DOI: 10.1007/s00296-017-3663-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/20/2017] [Indexed: 12/21/2022]
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Brodszky V, Bíró A, Szekanecz Z, Soós B, Baji P, Rencz F, Tóthfalusi L, Gulácsi L, Péntek M. Determinants of biological drug survival in rheumatoid arthritis: evidence from a Hungarian rheumatology center over 8 years of retrospective data. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:139-147. [PMID: 28243133 PMCID: PMC5317255 DOI: 10.2147/ceor.s124381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To compare drug survival of biological therapies in patients with rheumatoid arthritis (RA), and analyze the determinants of discontinuation probabilities and switches to other biological therapies. Materials and methods Consecutive RA patients initiating first biological treatment in one rheumatology center between 2006 and 2013 were included. Log-rank test was used to analyze the differences between the survival curves of different biological drugs. Cox regression was applied to analyze the discontinuation due to inefficacy, the occurrence of adverse events, or to any reasons. Results A total of 540 patients were included in the analysis. The most frequently used first-line biological treatments were infliximab (N=176, 33%), adalimumab (N=150, 28%), and etanercept (N=132, 24%). Discontinuation of first tumor necrosis factor-alpha (TNF-α) treatment was observed for 347 (64%) patients, due to inefficacy (n=209, 60%), adverse events (n=103, 30%), and other reasons (n=35, 10%). Drug survival rates for TNF-α and non-TNF-α therapies were significantly different, and were in favor of non-TNF-α therapies. Every additional number of treatment significantly increased the risk of inefficacy by 27% (p<0.001) and of adverse events by 35% (p=0.002). After the discontinuation of the initial TNF-α treatment, switching to rituximab and tocilizumab was associated with significantly longer treatment duration than switching to a second TNF-α. The non-TNF-α therapies resulted in significantly longer treatment duration, due to both less adverse events and longer maintenance of effectiveness. Conclusion Non-TNF-α therapies resulted in significantly longer treatment duration, and lost their effectiveness later. Increase in the number of switches significantly increased the risk of discontinuation of any biological therapy.
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Affiliation(s)
- Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Anikó Bíró
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; School of Economics, The University of Edinburgh, Edinburgh, UK
| | - Zoltán Szekanecz
- Department of Rheumatology, Institute of Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Boglárka Soós
- Department of Rheumatology, Institute of Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Semmelweis University Doctoral School of Clinical Medicine, Budapest, Hungary
| | - László Tóthfalusi
- Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Department of Rheumatology, Flór Ferenc County Hospital, Kistarcsa, Hungary
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60
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Goel N, Chance K. Biosimilars in rheumatology: understanding the rigor of their development. Rheumatology (Oxford) 2017; 56:187-197. [PMID: 27241704 PMCID: PMC5410928 DOI: 10.1093/rheumatology/kew206] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/30/2016] [Indexed: 11/23/2022] Open
Abstract
This article examines the current landscape of biosimilar development in rheumatology. As misperceptions about biosimilars exist regarding their comparability to the reference products for clinical use, we review the development paradigm with the goal of improving rheumatologists' understanding of the rigor with which biosimilars are developed. With an emphasis on European Union and US markets, it gives an overview of some of the challenges and issues related to biosimilar development that need to be considered by rheumatologists in this increasingly growing therapeutic space.
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Affiliation(s)
- Niti Goel
- Advisory Services, Quintiles
- Department of Internal Medicine, Duke University School of Medicine
| | - Kamali Chance
- Biosimilars Center of Excellence, Quintiles, Durham, NC, USA
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Abstract
Etanercept (SB4) [Benepali(®)], a tumour necrosis factor inhibitor that is a biosimilar of reference etanercept (Enbrel(®)), is approved in the EU for use in all adult indications for which reference etanercept is approved, namely rheumatoid arthritis, axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis), psoriatic arthritis, and plaque psoriasis. The approval of etanercept (SB4) was based on the results of stringent comparability exercises designed to demonstrate similarity to reference etanercept in terms of quality, biological activity, efficacy, safety, and immunogenicity. In two well-designed clinical trials, etanercept (SB4) was equivalent to reference etanercept with regard to pharmacokinetic properties in healthy volunteers and in terms of efficacy in patients with moderate to severe rheumatoid arthritis despite methotrexate therapy. Longer-term efficacy (up to 52 weeks) was also similar in both treatment groups. Etanercept (SB4) was generally well tolerated, with a similar safety profile to that of reference etanercept. Preliminary results of the open-label extension period (100 weeks) suggest that transitioning from reference etanercept to etanercept (SB4) was associated with sustained efficacy and no change in the adverse event profile or immunogenicity. In conclusion, etanercept (SB4) provides therapeutically equivalent alternative in adult patients with autoimmune inflammatory diseases requiring treatment with etanercept.
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Affiliation(s)
- Celeste B Burness
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand.
| | - Sean T Duggan
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand
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Waller J, Sullivan E, Piercy J, Black CM, Kachroo S. Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany. Patient Prefer Adherence 2017; 11:519-530. [PMID: 28331299 PMCID: PMC5356924 DOI: 10.2147/ppa.s129333] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We examined rheumatologists' motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behavior and explored patient attitudes to biosimilars. METHODS Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken with German rheumatologists and patients with rheumatoid arthritis, ankylosing spondyloarthritis or psoriatic arthritis in 2015-2016. Rheumatologists provided data on their prescribing behavior and attitudes toward biosimilars and invited the next eight eligible consecutive consulting patients to complete a questionnaire. Rheumatologists were split into "investigative", "conservative" and "other" groups. RESULTS Overall, 50 rheumatologists and 261 patients participated. Biosimilars accounted for <10% of all biologic therapy prescriptions, and >95% of rheumatologists would prescribe a biooriginator rather than biosimilar as the first- or second-line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, and a small proportion of patients were unhappy when switched from a biooriginator to a biosimilar. Satisfaction with treatment was highest in patients who started treatment with a biooriginator prior to biosimilar availability. Patient concerns when starting treatment with a biooriginator or a biosimilar included not knowing enough about the drug (25%-41%), potential side effects (26%-32%) and potential long-term problems (19%-30%). CONCLUSION Study results demonstrate that there is some reluctance from patients to accept biosimilars and the need to educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and physician communication. There remains a need for further research into nonclinical switching and the long-term impact of prescribing biosimilars.
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Affiliation(s)
| | | | | | - Christopher M Black
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Sumesh Kachroo
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
- Correspondence: Sumesh Kachroo, Merck & Co., Inc., 126 East Lincoln Avenue, Rahway, NJ 07065, USA, Tel +1 732 594 3847, Email
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63
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Park SK, Park SH, Lee MY, Park JH, Jeong JH, Lee EK. Cost-effectiveness Analysis of Treatment Sequence Initiating With Etanercept Compared With Leflunomide in Rheumatoid Arthritis: Impact of Reduced Etanercept Cost With Patent Expiration in South Korea. Clin Ther 2016; 38:2430-2446.e3. [DOI: 10.1016/j.clinthera.2016.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/03/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022]
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64
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Biologic therapies and infections in the daily practice of three Italian rheumatologic units: a prospective, observational study. Clin Rheumatol 2016; 36:251-260. [DOI: 10.1007/s10067-016-3444-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 12/19/2022]
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65
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Hifinger M, Hiligsmann M, Ramiro S, Severens JL, Fautrel B, Watson V, Boonen A. Patients' preferences and economic considerations play an important role in treatment decisions: a discrete choice experiment among rheumatologists. Rheumatology (Oxford) 2016; 56:68-76. [PMID: 28028156 DOI: 10.1093/rheumatology/kew328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 08/02/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate to what extent rheumatologists consider economic aspects and patients' preferences when choosing drug treatments in patients with active RA. METHODS In a discrete choice experiment, rheumatologists were asked to choose between two unlabelled drug treatment options for a hypothetical RA patient with moderate disease activity who failed two synthetic DMARDs. Attributes and levels of drug treatments were selected based on existing literature, rheumatologists' opinion and expert consensus. This resulted in five attributes each described by three levels: efficacy (level of improvement and achieved state on DAS28), safety (probability of a serious adverse event), patients' preference (level of agreement), annual medication costs and cost-effectiveness (incremental cost-effectiveness ratio). An efficient experimental design generated 14 treatment choices and a random parameter logit model estimated the relative importance of attributes. RESULTS Sixty-three rheumatologists from the Netherlands contributed to the analysis; 44% were female and mean (sd) age was 49 (8) years. Drug efficacy had the strongest relative contribution to the drug choice (44%) followed by medication costs (24%), patients' preference (17%) and cost-effectiveness (14%). Patients' preferences were most relevant when patients disliked a proposed treatment. The risk of serious but uncommon or rare side effects only played a minor role in the treatment choice (1%). CONCLUSION In addition to drug efficacy, rheumatologists account for economic aspects and for patients' preferences when deciding on drugs. Decisions are more influenced by absolute costs than relative cost-effectiveness and by patients' disliking as opposed to favouring the treatment.
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Affiliation(s)
- Monika Hifinger
- CAPHRI Research Institute, Maastricht University .,Department of Internal Medicine, Maastricht University Medical Centre
| | - Mickael Hiligsmann
- CAPHRI Research Institute, Maastricht University.,Department of Health Services Research, Maastricht University, Maastricht
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden
| | - Johan L Severens
- Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam.,iMTA-Institute of Medical Technology Assessment, Erasmus Rotterdam University, Rotterdam, The Netherlands
| | - Bruno Fautrel
- GRC 08, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Department of Rheumatology, Pitie Salpetriere Hospital Paris, Pierre et Marie Curie University, France and
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Annelies Boonen
- CAPHRI Research Institute, Maastricht University.,Department of Internal Medicine, Maastricht University Medical Centre
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66
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Westhovens R, Annemans L. Costs of drugs for treatment of rheumatic diseases. RMD Open 2016; 2:e000259. [PMID: 27651923 PMCID: PMC5020678 DOI: 10.1136/rmdopen-2016-000259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 01/22/2023] Open
Abstract
The cost of drugs is becoming an issue worldwide, in particular for inflammatory rheumatic diseases. In the current review, an overview of the scene is given with a specific emphasis on accessibility for those patients in real need of the available expensive treatments. The authors propose 7 principles for discussion that need to be addressed and are a responsibility for all stakeholders in rheumatology.
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Affiliation(s)
- Rene Westhovens
- Department of Development and Regeneration , Skeletal Biology and Engineering Research Center KU Leuven, Rheumatology University Hospital Leuven , Leuven , Belgium
| | - Lieven Annemans
- Department of Public Health, I-CHER Interuniversity Centre for Health Economics Research, Ghent University , Ghent , Belgium
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67
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Rintelen B, Zwerina J, Herold M, Singer F, Hitzelhammer J, Halder W, Eichbauer-Sturm G, Puchner R, Stetter M, Leeb BF. Validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology: current practice of bDMARD therapy in rheumatoid arthritis in Austria. BMC Musculoskelet Disord 2016; 17:358. [PMID: 27550175 PMCID: PMC4994324 DOI: 10.1186/s12891-016-1207-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022] Open
Abstract
Background The purpose of the present study was to check the validity of data collected in BIOREG, the Austrian register for biological treatment in rheumatology, and to elucidate eventual differences with respect to disease activity (DA) in patients with rheumatoid arthritis (RA) on established biological DMARDs (bDMARDs) before inclusion into the register (EST) and beginners at the time point of inclusion (NEW) after 1 year of treatment. Methods RA patients with a complete follow-up of 1 year in BIOREG were divided into EST and NEW and compared with respect to DA, remission rates, concomitant synthetic DMARDs (csDMARDs) and glucocorticoid therapy (GC) at baseline and after 1-year follow-up. Safety concerns are listed. Descriptive statistics are applied. Results For 346 RA patients (284 EST, 62 NEW) out of 970 RA patients included into BIOREG, a full data set for a 1-year follow-up was available. No differences in DA were observed after 1 year as expressed by DAS28 or RADAI-5, and small differences as expressed by remission rates according to DAS28, RADAI-5 or Boolean criteria (namely approximately 1/2, 1/3 to 1/4 and 1/4 to 1/5 of the patients respectively). Sixty-four adverse events (AEs) were noted in 56 (20 %) of EST and 20 in 19 (31 %) of NEW patients. Malignancy occurred in four patients. After 1 year, 48 % of EST patients but only 16 % of NEW patients were on bDMARD monotherapy. Conclusion Regarding DA, the date collected in BIOREG appeared to be valid. After 1 year of bDMARD therapy, all patients, whether EST or NEW, achieved a similar level of DA. AEs occurred more frequently during the early phase of bDMARD treatment. Austrian rheumatologists initiate bDMARD therapy in patients with lower disease levels than in other European countries, leading to high remission rates.
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Affiliation(s)
- Bernhard Rintelen
- Lower Austrian State Hospital Stockerau, 2nd Department for internal medicine, Lower Austrian Center for Rheumatology, Landstrasse 18, Stockerau, 2000, Austria. .,Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, Stockerau, 2000, Austria.
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Heinrich-Collinstrasse 30, Vienna, 1140, Austria
| | - Manfred Herold
- Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Franz Singer
- BIOREG, Schloßhoferstrasse 4/4/12, Vienna, 1221, Austria
| | - Johann Hitzelhammer
- Health Center Vienna Mariahilf, Wiener Gebietskrankenkasse, Mariahilfer Strasse 85-87, Vienna, 1060, Austria
| | | | | | - Rudolf Puchner
- Office based rheumatologist, Freiung 19, Wels, 4070, Austria
| | - Miriam Stetter
- Department for Internal Medicine, Lower Austrian State Hospital Amstetten, Krankenhausstrasse 21, Amstetten, 3300, Austria
| | - Burkhard F Leeb
- Lower Austrian State Hospital Stockerau, 2nd Department for internal medicine, Lower Austrian Center for Rheumatology, Landstrasse 18, Stockerau, 2000, Austria.,Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, Stockerau, 2000, Austria.,Medical University of Graz, Auenbruggerplatz 2, Graz, 8010, Austria
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68
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Araújo FC, Gonçalves J, Fonseca JE. Pharmacoeconomics of Biosimilars: What Is There to Gain from Them? Curr Rheumatol Rep 2016; 18:50. [DOI: 10.1007/s11926-016-0601-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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69
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Hifinger M, Hiligsmann M, Ramiro S, Watson V, Severens JL, Fautrel B, Uhlig T, van Vollenhoven R, Jacques P, Detert J, Canas da Silva J, Scirè CA, Berghea F, Carmona L, Péntek M, Keat A, Boonen A. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists. Ann Rheum Dis 2016; 76:126-132. [PMID: 27190098 DOI: 10.1136/annrheumdis-2016-209202] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/27/2016] [Accepted: 04/20/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. METHODS In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. RESULTS Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. CONCLUSIONS Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals.
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Affiliation(s)
- M Hifinger
- CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Hiligsmann
- CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - V Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - J L Severens
- Institute for Health Policy and Management, Erasmus Rotterdam University, Rotterdam, The Netherlands
| | - B Fautrel
- Department of Rheumatology, University Paris 6, GRC-UPMC08, Pierre Louis Institute of Epidemiology and Public Health-AP-HP, Pitie Salpetriere University Hospital, Paris, France
| | - T Uhlig
- National Advisory Unit for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo, Oslo, Norway
| | - R van Vollenhoven
- Unit for Clinical Therapy Research Inflammatory Diseases, Karolinska Institute, Stockholm, Sweden
| | - P Jacques
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium
| | - J Detert
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Canas da Silva
- Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal
| | - C A Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - F Berghea
- Department of Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - L Carmona
- Department of Rheumatology, Instituto de Salud Musculoesqueletica, Madrid, Spain
| | - M Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Department of Rheumatology, Flór Ferenc Hospital, Kistarcsa, Hungary
| | - A Keat
- Arthritis Centre, Northwick Park Hospital, Harrow, UK
| | - A Boonen
- CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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70
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Putrik P, Ramiro S, Lie E, Keszei AP, Kvien TK, van der Heijde D, Landewé R, Uhlig T, Boonen A. Less educated and older patients have reduced access to biologic DMARDs even in a country with highly developed social welfare (Norway): results from Norwegian cohort study NOR-DMARD. Rheumatology (Oxford) 2016; 55:1217-24. [PMID: 27012686 DOI: 10.1093/rheumatology/kew048] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To explore whether age, gender or education influence the time until initiation of the first bDMARD in patients with RA. METHODS Data from the Norwegian Register of DMARDs collected between 2000 and 2012 were used. Only DMARD-naïve patients with RA starting their first conventional synthetic DMARD were included in the analyses. The start of the first bDMARD was the main outcome of interest. Cox regression analyses were used to explore the impact of education, age and gender on the start of a first bDMARD, adjusting for confounders, either at baseline or varying over time (time-varying model). RESULTS Of 1946 eligible patients [mean (s.d.) age: 55 (14) years, 68% females], 368 (19%) received a bDMARD during follow-up (mean 2.6 years). In the baseline prediction model, older age [Hazard Ratio (HR) 0.97, 95% CI: 0.96, 0.98], lower education [HR = 0.76 and 0.68 for low and intermediate education levels vs college/university education, respectively (P = 0.01)] and female gender [only in the period 2000-03, HR = 0.61 (95% CI: 0.41, 0.91)] were associated with a lower hazard ratio to start a bDMARD. The time-varying model provided overall consistent results, but the effect of education was only relevant for older patients (>57 years) and became more pronounced by the end of the decade. CONCLUSIONS Less educated and older patients have disadvantages with regard to access to costly treatments, even in a country with highly developed welfare like Norway. Females had lower access in the beginning of the 2000s, but access had improved by the end of the decade.
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Affiliation(s)
- Polina Putrik
- Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Health Promotion and Education, Maastricht University, Maastricht
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Andras P Keszei
- Medical Informatics, Uniklinik RWTH Aachen University, Aachen, Germany
| | - Tore K Kvien
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Robert Landewé
- Amsterdam Rheumatology & Immunology Center, Amsterdam, Amsterdam Rheumatology, Atrium Medical Center, Heerlen, the Netherlands and
| | - Till Uhlig
- Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Rheumatology, Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
| | - Annelies Boonen
- Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University
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Dörner T, Strand V, Cornes P, Gonçalves J, Gulácsi L, Kay J, Kvien TK, Smolen J, Tanaka Y, Burmester GR. The changing landscape of biosimilars in rheumatology. Ann Rheum Dis 2016; 75:974-82. [PMID: 26964144 PMCID: PMC4893105 DOI: 10.1136/annrheumdis-2016-209166] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 12/30/2022]
Abstract
Biosimilars remain a hot topic in rheumatology, and some physicians are cautious about their application in the real world. With many products coming to market and a wealth of guidelines and recommendations concerning their use, there is a need to understand the changing landscape and the real clinical and health-economic potential offered by these agents. Notably, rheumatologists will be at the forefront of the use of biosimilar monoclonal antibodies/soluble receptors. Biosimilars offer cost savings and health gains for our patients and will play an important role in treating rheumatic diseases. We hope that these lower costs will compensate for inequities in access to therapy based on economic differences across countries. Since approved biosimilars have already demonstrated highly similar efficacy, it will be most important to establish pharmacovigilance databases across countries that are adequate to monitor long-term safety after marketing approval.
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Affiliation(s)
- Thomas Dörner
- Department of Medicine/Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany Deutsches Rheumaforschungszentrum (DRFZ), Berlin, Germany
| | - Vibeke Strand
- Division Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - João Gonçalves
- Faculty of Pharmacy at University of Lisbon, iMed- Research Institute for Medicines, Portugal
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Josef Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Gerd R Burmester
- Department of Medicine/Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
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Gulácsi L, Rencz F, Poór G, Szekanecz Z, Brodszky V, Baji P, Péntek M. Patients' access to biological therapy in chronic inflammatory conditions; per capita GDP does not explain the intercountry differences. Ann Rheum Dis 2016; 75:942-3. [PMID: 26888946 DOI: 10.1136/annrheumdis-2015-208741] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/31/2016] [Indexed: 12/31/2022]
Affiliation(s)
- László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Gyula Poór
- First Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, University of Debrecen Medical and Health Science Center, Institute of Medicine, Debrecen, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary Department of Rheumatology and Physiotherapy, Flór Ferenc County Hospital, Kistarcsa, Hungary
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73
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Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compán MV, Oliver S, Schoels M, Scholte-Voshaar M, Stamm T, Stoffer M, Takeuchi T, Aletaha D, Andreu JL, Aringer M, Bergman M, Betteridge N, Bijlsma H, Burkhardt H, Cardiel M, Combe B, Durez P, Fonseca JE, Gibofsky A, Gomez-Reino JJ, Graninger W, Hannonen P, Haraoui B, Kouloumas M, Landewe R, Martin-Mola E, Nash P, Ostergaard M, Östör A, Richards P, Sokka-Isler T, Thorne C, Tzioufas AG, van Vollenhoven R, de Wit M, van der Heijde D. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016; 75:3-15. [PMID: 25969430 PMCID: PMC4717393 DOI: 10.1136/annrheumdis-2015-207524] [Citation(s) in RCA: 963] [Impact Index Per Article: 120.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. OBJECTIVE To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. METHODS A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. RESULTS The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). CONCLUSIONS The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd R Burmester
- Department of Rheumatology, Clinical Immunology Free University and Humboldt University, Charité-University Medicine, Berlin, Germany
| | - Vivian Bykerk
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, USA
| | - Maxime Dougados
- Department of Rheumatology B, Cochin Hospital, René Descartes University, Paris, France
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital,Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Monika Schoels
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Marieke Scholte-Voshaar
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Tanja Stamm
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Michaela Stoffer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose Louis Andreu
- Rheumatology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Martin Aringer
- Department of Medicine III, University Medical Center TU Dresden, Dresden, Germany
| | - Martin Bergman
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Neil Betteridge
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Hans Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, and VU University Medical Center, Amsterdam, The Netherlands
| | - Harald Burkhardt
- Division of Rheumatology, Department of Medicine, Johann-Wolfgang-Goethe University Frankfurt, German
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - Bernard Combe
- Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France
| | - Patrick Durez
- Pôle de Recherche en Rhumatologie, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joao Eurico Fonseca
- Rheumatology Research Unit, Instituto de de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Alan Gibofsky
- Weill Medical College, Cornell University Hospital for Special Surgery, New York, USA
| | - Juan J Gomez-Reino
- Rheumatology Unit, Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Pekka Hannonen
- Department of Medicine, Central Hospital, Jyväskylä, Finland
| | | | - Marios Kouloumas
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Robert Landewe
- Academic Medical Center, University of Amsterdam, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | | | - Peter Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - Mikkel Ostergaard
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Östör
- Rheumatology Clinical Research Unit, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Pam Richards
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | | | - Carter Thorne
- Division of Rheumatology, Southlake Regional Health Centre, Newarket, Ontario, Canada
| | | | | | - Martinus de Wit
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Desirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Braun J, Kudrin A. Progress in biosimilar monoclonal antibody development: the infliximab biosimilar CT-P13 in the treatment of rheumatic diseases. Immunotherapy 2015; 7:73-87. [PMID: 25713985 DOI: 10.2217/imt.14.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Biosimilars are biologic medical products whose active drug substance is made by a living organism or derived from it. The term is used to describe a subsequent version of an innovator biopharmaceutical product aiming at approval following patent expiry on the reference product. Biosimilars of monoclonal need to demonstrate similar but not identical quality of nonclinical and clinical attributes. Not all data of the originator product need to be recapitulated, as large numbers of patient-years of exposure data are already available. Thus, biosimilar development is largely based on the safety profiles of the originator product. The evaluation of biosimilarity includes immunogenicity attributed risks. CT-P13 (Remsima™/Inflectra™, Celltrion/Hospira), a biosimilar of the innovator drug infliximab (INF), was the first approved complex biosimilar monoclonal antibody in the EU, within the framework of WHO, EMA and US FDA biosimilar guidelines. CT-P13 has shown analytical and nonclinical features highly similar to INF including pharmacokinetics, efficacy, safety and immunogenicity profiles in ankylosing spondylitis and rheumatoid arthritis. The objective of this article is to highlight the recent biosimilar development and to review the results from the studies PLANETRA and PLANETAS, which have supported the approval of CT-P13 for several indications.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649 Herne, & Ruhr Universität Bochum, Germany
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Nikiphorou E, Kautiainen H, Hannonen P, Asikainen J, Kokko A, Rannio T, Sokka T. Clinical effectiveness of CT-P13 (Infliximab biosimilar) used as a switch from Remicade (infliximab) in patients with established rheumatic disease. Report of clinical experience based on prospective observational data. Expert Opin Biol Ther 2015; 15:1677-83. [DOI: 10.1517/14712598.2015.1103733] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Souliotis K, Alexopoulou E, Papageorgiou M, Politi A, Litsa P, Contiades X. Access to Care for Multiple Sclerosis in Times of Economic Crisis in Greece--the HOPE II Study. Int J Health Policy Manag 2015; 5:83-9. [PMID: 26927393 DOI: 10.15171/ijhpm.2015.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 09/23/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While there is currently no cure for multiple sclerosis (MS), treatment with biologic disease-modifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients' experiences. METHODS A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. RESULTS During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. CONCLUSION Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece.,Centre for Health Services Research, Medical School, University of Athens, Athens, Greece
| | - Elena Alexopoulou
- Faculty of Social Sciences, University of Peloponnese, Corinth, Greece.,National Organization for Healthcare Services Provision, Athens, Greece
| | | | - Anastasia Politi
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Panagiota Litsa
- Centre for Health Services Research, Medical School, University of Athens, Athens, Greece
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Finckh A, Neto D, Iannone F, Loza E, Lie E, van Riel P, Hetland ML, Pavelka K, Gottenberg JE, Canhão H, Mariette X, Turesson C. The impact of patient heterogeneity and socioeconomic factors on abatacept retention in rheumatoid arthritis across nine European countries. RMD Open 2015; 1:e000040. [PMID: 26509062 PMCID: PMC4613166 DOI: 10.1136/rmdopen-2014-000040] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 01/06/2023] Open
Abstract
Background There are substantial differences in accessibility to biological disease modifying antirheumatic drugs (bDMARDs) across countries. The objective of this study was to analyse the impact of patient demographics, disease characteristics and gross domestic product (GDP) on abatacept (ABA) retention in patients with rheumatoid arthritis (RA) treated in clinical practice. Methods Data from nine European observational RA cohorts of patients treated with ABA were pooled. Kaplan-Meier analysis was used to compare drug retention across registries. Specific causes of drug retention were investigated using competing risks multivariate Cox regression. Results A total of 3961 patients treated with ABA, with 6188 patient-years of follow-up, were included. Patients in the different national registries had similar demographic features, but varied in baseline disease characteristics. ABA drug retention differed between countries, with median drug retention rates ranging from 1.2 to more than 6 years. The differences in drug retention were marginally explained by disparities in disease characteristics, while the national GDP per capita was strongly associated with drug retention (correlation coefficient −0.74; p=0.02). Conclusions Patient characteristics at ABA initiation vary across Europe, probably reflecting differences in eligibility criteria and prescription patterns. However, the difference in ABA drug retention between countries was not primarily explained by disparities in patient characteristics. Lower ABA retention was observed in countries with a more liberal access to bDMARDs and higher GDP. National differences need to be accounted for when pooling data on treatment with bDMARDs from various countries.
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Affiliation(s)
- A Finckh
- SCQM-RA , Switzerland ; Geneva University , Geneva , Switzerland
| | - D Neto
- Geneva University , Geneva , Switzerland
| | - F Iannone
- GISEA, Rheumatology Unit, Interdisciplinary Department of Medicine, University of Bari, Italy
| | | | - E Lie
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway ; NOR-DMARD , Norway
| | | | - M L Hetland
- DANBIO, Center for Rheumatology and Spine Diseases,Rigshospitalet, Glostrup, Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | | | - J E Gottenberg
- Department of Rheumatology , ORA, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg , France
| | | | - X Mariette
- ORA, Rhumatologie, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicetre, Université Paris-Sud, France
| | - C Turesson
- ARTIS, Sweden ; Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden ; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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Putrik P, Ramiro S, Keszei AP, Hmamouchi I, Dougados M, Uhlig T, Kvien TK, Boonen A. Lower education and living in countries with lower wealth are associated with higher disease activity in rheumatoid arthritis: results from the multinational COMORA study. Ann Rheum Dis 2015; 75:540-6. [DOI: 10.1136/annrheumdis-2014-206737] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/06/2015] [Indexed: 02/02/2023]
Abstract
ObjectivesTo investigate the relationship of socioeconomic status (SES) on an individual and country level with disease activity in rheumatoid arthritis (RA) and explore the mediating role of uptake of costly biological disease-modifying antirheumatic drugs (bDMARDs) in this relationship.MethodsData from a cross-sectional multinational study (COMOrbidities in RA) were used. Contribution of individual socioeconomic factors and country of residence to disease activity score with 28-joint assessment (DAS28) was explored in regression models, adjusting for relevant clinical confounders. Next, country of residence was replaced by gross domestic product (GDP) (low vs high) to investigate the contribution of SES by comparing R2 (model fit). The mediating role of uptake of bDMARDs in the relationship between education or GDP and DAS28 was explored by testing indirect effects.ResultsIn total, 3920 patients with RA were included (mean age 56 (SD 13) years, 82% women, mean DAS28 3.7 (1.6)). After adjustment, women (vs men) and low-educated (vs university) patients had 0.35 higher DAS28. Adjusted country differences in DAS28, compared with the Netherlands (lowest DAS28), varied from +0.2 (France) to +2.4 (Egypt). Patients from low GDP countries had 0.98 higher DAS28. No interactions between individual-level and country-level variables were observed. A small mediation effect of uptake of bDMARDs in the relationship between education and DAS28 (7.7%) and between GDP and DAS28 (6.7%) was observed.ConclusionsFemale gender and lower individual or country SES were independently associated with DAS28, but did not reinforce each other. The association between lower individual SES (education) or lower country welfare (GDP) with higher DAS28 was partially mediated by uptake of bDMARDs.
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Péntek M, Poór G, Wiland P, Olejárová M, Brzosko M, Codreanu C, Brodszky N, Gulácsi L. Biological therapy in inflammatory rheumatic diseases: issues in Central and Eastern European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15 Suppl 1:S35-S43. [PMID: 24832834 DOI: 10.1007/s10198-014-0592-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/31/2014] [Indexed: 06/03/2023]
Abstract
Biological drugs revolutionized the treatment of inflammatory rheumatic diseases. Access to treatment presents substantial variability across Europe. The economic level of a particular country as well as administrative restrictions have been proved as determining factors of biological drug uptake. The objective of this paper was to provide an overview of biological treatment in six selected Central and Eastern European (CEE) countries, namely in the Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia. The literature is summarized with regard to the epidemiology, disease burden and use of biological agents in rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Moreover, an estimate is provided on the prevalence and number of patients with biological treatment based on international and local sources. In view of the limited availability of information and uncertainty in data, there is an urgent need for development of systematic and comprehensive data collection in inflammatory rheumatic diseases in CEE countries.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary,
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Verstappen SM. Outcomes of early rheumatoid arthritis – The WHO ICF framework. Best Pract Res Clin Rheumatol 2013; 27:555-70. [DOI: 10.1016/j.berh.2013.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
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