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Bertrand D, Deprez A, Doumen M, De Cock D, Pazmino S, Marchal A, Thelissen M, Joly J, De Meyst E, Neerinckx B, Westhovens R, Verschueren P. To flare or not to flare: patients' and rheumatologists' perceptions on the on-flare retreatment strategy of rituximab in rheumatoid arthritis. Ther Adv Musculoskelet Dis 2024; 16:1759720X241232268. [PMID: 38425577 PMCID: PMC10903194 DOI: 10.1177/1759720x241232268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Background Several retreatment strategies exist for rituximab in rheumatoid arthritis (RA). In some countries, reimbursement criteria require a loss of disease control for rituximab retreatment. Understanding the patients' and rheumatologists' perceptions regarding this retreatment strategy would be informative in identifying the optimal treatment administration schedule. Objectives This study aimed to uncover patients' and rheumatologists' perceptions regarding retreatment strategies of rituximab. Design Qualitative study - semi-structured interviews. Methods Patients with RA, treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in-depth, semi-structured interviews. Interviews were analysed according to the Qualitative Analysis Guide of Leuven. Results A total of 16 patients and 13 rheumatologists were interviewed. Benefits (e.g. decreased risk of overtreatment, cost savings and long-lasting effectiveness of rituximab) and barriers (e.g. fluctuating disease activity, slow mode of action and increased glucocorticoid use) of on-flare retreatment were identified. To effectively treat on-flare, flares must first be identified timely. Both stakeholder groups acknowledged that patients are capable of recognizing flares. However, the patient's ability to discriminate between inflammatory and other types of pain was perceived as difficult. Furthermore, patients and rheumatologists stressed that patients must timely seek professional help in case of a flare, followed by a swift response from the rheumatologists. Remarkably, retreatment was approached in various ways among rheumatologists, and not always adhering strictly to the on-flare reimbursement criteria. Conclusion This study revealed that both stakeholder groups perceived the heterogeneity in recognition of and reaction to a flare as important in influencing the effectiveness of the on-flare retreatment strategy. Moreover, this study identified the benefits and barriers of treating on-flare, which could be informative for daily practice decisions.
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Affiliation(s)
- Delphine Bertrand
- Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium
| | - Anke Deprez
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- KU Leuven, Department of Public Health and Primary Care, Environment and Health, Leuven, Belgium
| | - Michaël Doumen
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- UZ Leuven, Rheumatology, Leuven, Belgium
| | - Diederik De Cock
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- Biostatistics and Medical Informatics Research Group, Department of Public Health Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sofia Pazmino
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- KU Leuven, Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, Leuven, Belgium
| | | | | | - Johan Joly
- UZ Leuven, Rheumatology, Leuven, Belgium
| | - Elias De Meyst
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- UZ Leuven, Rheumatology, Leuven, Belgium
| | - Barbara Neerinckx
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- UZ Leuven, Rheumatology, Leuven, Belgium
| | - René Westhovens
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- UZ Leuven, Rheumatology, Leuven, Belgium
| | - Patrick Verschueren
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- UZ Leuven, Rheumatology, Leuven, Belgium
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Sussman M, Tao C, Patel P, Tundia N, Clewell J, Menzin J. Cost-utility analyses of targeted immunomodulators in rheumatoid arthritis: systematic review. J Med Econ 2020; 23:610-623. [PMID: 31971039 DOI: 10.1080/13696998.2020.1720219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: Cost-utility (CU) modeling is a common technique used to determine whether new treatments represent good value for money. As with any modeling exercise, findings are a direct result of methodology choices, which may vary widely. Several targeted immuno-modulators have been launched in recent years to treat moderate-to-severe rheumatoid arthritis (RA) which have been evaluated using CU methods. Our objectives were to identify common and innovative modeling choices in moderate-to-severe RA and to highlight their implications for future models in RA.Materials and methods: A systematic literature search was conducted to identify CU models in moderate-to-severe RA published from January 2013 to June 2019. Studies must have included an active comparator and used quality-adjusted life-years (QALYs) as the common measure of effectiveness. Modeling methods were characterized by stakeholder perspective, simulation type, mapping between parameters, and data sources.Results: Thirty-one published modeling studies were reviewed spanning 13 countries and 9 drugs, with common methodological choices and innovations observed among them. Over the evaluated time period, we observed common methods and assumptions that are becoming more prominent in the RA CU modeling landscape, including patient-level simulations, two-stage models combining trial results and real-world evidence, real-world treatment durations, long-term health consequences, and Health Assessment Questionnaire (HAQ)-related hospitalization costs. Models that consider the societal perspective are increasingly being developed as well.Limitations: This review did not consider studies that did not report QALYs as a utility measure, models published only as conference abstracts, or cost-consequence models that did not report an incremental CU ratio.Conclusions: CU modeling for RA increasingly reflects real-world conditions and patient experiences which are anticipated to provide better information in the assessment of health technologies. Future CU models in RA should consider applying the observed advances in modeling choices to optimize their CU predictions and simulation of real-world outcomes.
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Affiliation(s)
- Matthew Sussman
- Modeling and Evidence, Boston Health Economics, LLC, Boston, MA, USA
| | - Charles Tao
- Modeling and Evidence, Boston Health Economics, LLC, Boston, MA, USA
| | - Pankaj Patel
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Namita Tundia
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Jerry Clewell
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Joseph Menzin
- Modeling and Evidence, Boston Health Economics, LLC, Boston, MA, USA
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Chatzidionysiou K, Lie E, Lukina G, Hetland ML, Hauge EM, Pavelka K, Gabay C, Scherer A, Nordström D, Canhao H, Santos MJ, Tomsic M, Rotar Z, Hernández MV, Gomez-Reino J, Ancuta I, Kvien TK, van Vollenhoven R. Rituximab Retreatment in Rheumatoid Arthritis in a Real-life Cohort: Data from the CERERRA Collaboration. J Rheumatol 2017; 44:162-169. [DOI: 10.3899/jrheum.160460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 12/24/2022]
Abstract
Objective.Several aspects of rituximab (RTX) retreatment in rheumatoid arthritis (RA) need to be further elucidated. The aim of this study was to describe the effect of repeated courses of RTX on disease activity and to compare 2 retreatment strategies, fixed-interval versus on-flare retreatment, in a large international, observational, collaborative study.Methods.In the first analysis, patients with RA who received at least 4 cycles with RTX were included. In the second analysis, patients who received at least 1 RTX retreatment and for whom information about the strategy for retreatment was available were identified. Two retreatment strategies (fixed-interval vs on-flare) were compared by fitting-adjusted, mixed-effects models of 28-joint Disease Activity Score (DAS28) over time for first and second retreatment.Results.A total of 1530 patients met the eligibility criteria for the first analysis. Significant reductions of mean DAS28 between the starts of subsequent treatment cycles were observed (at start of first treatment cycle: 5.5; second: 4.3; third: 3.8; and fourth: 3.5), suggesting improved response after each additional cycle (p < 0.0001 for all pairwise comparisons). A total of 800 patients qualified for the second analysis: 616 were retreated on flare and 184 at fixed interval. For the first retreatment, the fixed-interval retreatment group yielded significantly better results than the on-flare group (estimated marginal mean DAS28 = 3.8, 95% CI 3.6–4.1 vs 4.6, 95% CI 4.5–4.7, p < 0.0001). Similar results were found for the second retreatment.Conclusion.Repeated treatment with RTX leads to further clinical improvement after the first course of RTX. A fixed-interval retreatment strategy seems to be more effective than on-flare retreatment.
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