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Du X, Mi J, Cheng H, Song Y, Li Y, Sun J, Chan P, Chen Z, Luo S. Uptake of hepatitis C direct-acting antiviral treatment in China: a retrospective study from 2017 to 2021. Infect Dis Poverty 2023; 12:28. [PMID: 36978198 PMCID: PMC10043849 DOI: 10.1186/s40249-023-01081-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) for hepatitis C treatment in China became available since 2017. This study expects to generate evidence to inform decision-making in a nationwide scale-up of DAA treatment in China. METHODS We described the number of standard DAA treatment at both national and provincial levels in China from 2017 to 2021 based on the China Hospital Pharmacy Audit (CHPA) data. We performed interrupted time series analysis to estimate the level and trend changes of the monthly number of standard DAA treatment at national level. We also adopted the latent class trajectory model (LCTM) to form clusters of the provincial-level administrative divisions (PLADs) with similar levels and trends of number of treatment, and to explore the potential enablers of the scale-up of DAA treatment at provincial level. RESULTS The number of 3-month standard DAA treatment at national level increased from 104 in the last two quarters of 2017 to 49,592 in the year of 2021. The estimated DAA treatment rates in China were 1.9% and 0.7% in 2020 and 2021, which is far below the global target of 80%. The national price negotiation at the end of 2019 resulted in DAA inclusion by the national health insurance in January 2020. In that month, the number of treatment increased 3668 person-times (P < 0.05). LCTM fits the best when the number of trajectory class is four. PLADs as Tianjin, Shanghai and Zhejiang that had piloted DAA price negotiations before the national negotiation and that had explored integration of hepatitis service delivery with prevention and control programme of hepatitis C within the existing services demonstrated earlier and faster scale-up of treatment. CONCLUSIONS Central negotiations to reduce prices of DAAs resulted in inclusion of DAA treatment under the universal health insurance, which are critical elements that support scaling up access to hepatitis C treatment in China. However, the current treatment rates are still far below the global target. Targeting the PLADs lagged behind through raising public awareness, strengthening capacity of the healthcare providers by roving training, and integrate prevention, screening, diagnosis, treatment and follow-up management of hepatitis C into the existing services are needed.
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Affiliation(s)
- Xinyu Du
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Jiarun Mi
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Hanchao Cheng
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Yuanyuan Song
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Yuchang Li
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdansantiao, Dongcheng District, Beijing, 100730, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Polin Chan
- Hepatitis/TB/HIV/STI, World Health Organisation Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, The Philippines
| | - Zhongdan Chen
- Hepatitis/TB/HIV/STI, World Health Organisation Representative Office in China, 401 Dongwai Diplomatic Building 23, Dongzhimenwai Dajie, Chaoyang District, Beijing, 100600, China
| | - Simon Luo
- IQVIA Holding Company, 138 Wangfujing street, Xindongan Palza, Block 3, Beijing, 100006, China
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Miregwa BN, Holbrook A, Law MR, Lavis JN, Thabane L, Dolovich L, Wilson MG. The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis. CMAJ Open 2022; 10:E848-E855. [PMID: 36167420 PMCID: PMC9578752 DOI: 10.9778/cmajo.20210295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2018, Ontario implemented a pharmacare program (Ontario Health Insurance Plan Plus [OHIP+]) to provide children and youth younger than 25 years with full coverage for prescription medications in the provincial formulary. We aimed to assess the use of public drug plans and costs of publicly covered prescriptions before and after the program's implementation and modification. METHODS We conducted a population-based, interrupted time-series analysis using data on prescription drug claims, from the Canadian Institute for Health Information's National Prescription Drug Utilization Information System, for people younger than 25 years from January 2016 to October 2019 in Ontario, using British Columbia as the control. We assessed changes in the level and trend of publicly covered prescriptions and expenditures after the introduction of OHIP+ in January 2018 and after program modifications in April 2019. We also assessed plan use and expenditures for publicly covered prescriptions for diabetes and asthma. RESULTS Publicly covered prescriptions in Ontario increased by 290%, from 756 per 1000 people before OHIP+ to 2952 per 1000 (p < 0.001) after its implementation. After program modification, prescriptions decreased by 52% to 1421 per 1000 (p < 0.001). Similarly, total public drug expenditures increased by 254%, from $379 million in 2017 to $839 million in 2018, then reduced by 49% to $204 million in 2019. Monthly public plan expenditures increased by $115.94 (95% confidence interval [CI] $100.93 to $130.94) post-OHIP+ implementation and decreased by $99.97 (95% CI -$119.79 to -$80.15) per person per month after April 2019. INTERPRETATION Adopting OHIP+ increased use of public drug plans and expenditures for publicly funded prescription medicines, and the program modification was associated with decreases in both outcomes. This study's findings can inform the national pharmacare debate; future research should investigate associations with health outcomes.
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Affiliation(s)
- Benard N Miregwa
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont.
| | - Anne Holbrook
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Michael R Law
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - John N Lavis
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Lehana Thabane
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Lisa Dolovich
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Michael G Wilson
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
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National reimbursement databases: use and limitations for rheumatologic studies. Joint Bone Spine 2022; 89:105369. [DOI: 10.1016/j.jbspin.2022.105369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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Rojas-Giménez M, Mena-Vázquez N, Romero-Barco CM, Manrique-Arija S, Ureña-Garnica I, Diaz-Cordovés G, Jiménez-Núñez FG, Fernández-Nebro A. Effectiveness, safety and economic analysis of Benepali in clinical practice. REUMATOLOGIA CLINICA 2021; 17:588-594. [PMID: 34823826 DOI: 10.1016/j.reumae.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/29/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the effectiveness, safety and cost of Etanercept biosimilar in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) compared to the standard drug in real clinical practice. PATIENTS AND METHODS Retrospective observational study. Case series of 138 patients with RA, SpA or PsA treated with at least one dose of Benepali® (n = 79) or Enbrel® (n = 59). Drug retention time was the primary efficacy endpoint compared to the biosimilar and the original. The proportion of patients achieving low disease activity or remission after 52 weeks was used as the secondary outcome. Safety was assessed by means of the adverse effects incidence rate. A cost minimization analysis was performed. RESULTS No differences were observed regarding treatment retention time between drugs (median [95% confidence interval, 95% CI] at 12.0 months [10.2-12.0] for the biosimilar and 12.0 months [12.0-12.0] for the original). Similar improvements, in terms of inflammatory activity and physical function, were obtained after 52 weeks except for patients with SpA and PsA who, in general, experienced improvements of BASDAI and ASDAS with the original compared with the biosimilar. No significant differences were observed in the total number of adverse effects (.43 events/patient-years versus the biosimilar and .53 versus the original). Using the biosimilar in place of the original drug resulted in a net savings of 118,383.55 € (1,747.20 €/patient-years) for the hospital. CONCLUSION The biosimilar Benepali is as effective and safe as the original and much more cost-effective.
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Affiliation(s)
- Marta Rojas-Giménez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Carmen María Romero-Barco
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Inmaculada Ureña-Garnica
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Gisela Diaz-Cordovés
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Francisco Gabriel Jiménez-Núñez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina, Universidad de Málaga, Málaga, Spain
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Yu CL, Yang CH, Chi CC. Drug Survival of Biologics in Treating Ankylosing Spondylitis: A Systematic Review and Meta-analysis of Real-World Evidence. BioDrugs 2021; 34:669-679. [PMID: 32946076 DOI: 10.1007/s40259-020-00442-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The last decade has witnessed the increasing use of biologics for the treatment of ankylosing spondylitis (AS). Drug survival is an outcome incorporating real-world effectiveness and safety. However, the drug survival of biologics in treating AS is unclear. OBJECTIVE The aim was to assess the drug survival of biologics (tumor necrosis factor inhibitors and anti-interleukin-17 monoclonal antibodies) in treating AS. METHODS We conducted a systematic review and meta-analysis and searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases up to 13th May 2020. Studies that analyzed the drug survival of biologics for AS and reported the respective annual data for each biologic for at least 1 year were included. Two authors independently screened and selected studies and assessed their risk of bias. A third author was available for arbitrating discrepancies. The Newcastle-Ottawa Scale was employed to evaluate the risk of bias of included studies. We conducted a random-effects model meta-analysis to obtain pooled drug survival from year 1 to 5. We performed subgroup analyses for biologic-naïve patients, first-line versus second- and third-line biologics, discontinuation due to loss of effectiveness and adverse effects, and high-quality studies. RESULTS We included 39 studies with 32,493 patients. The drug survival decreased from 76% at year 1 to 51% at year 5 for etanercept, from 75 to 51% for adalimumab, from 76 to 53% for infliximab, from 72 to 49% for golimumab, and from 63 to 57% for certolizumab pegol. The drug survival rate for secukinumab was 0.77 (95% confidence interval 0.64‒0.90) at year 1. Subgroup analyses on biologic-naïve patients and discontinuation due to adverse effects found no differences in the drug survival of various biologics except for a lower drug survival of infliximab in biologic-naïve patients. The drug survival for first-line biologics was higher than for second- and third-line biologics. CONCLUSION To the best of our knowledge, this study is the first systematic review and meta-analysis on the drug survival of biological therapies for AS patients. The drug survival of all biologics in treating AS appeared comparable, but is higher in first-line biologics than second- and third-line biologics. To date there are scarce data on the drug survival of newly available biologics, for example, anti-interleukin-17 biologics. PROSPERO REGISTRATION NO CRD42018114204.
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Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chung-Han Yang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan, 33305, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Zhang L, Chen F, Geng S, Wang X, Gu L, Lang Y, Li T, Ye S. Methotrexate (MTX) Plus Hydroxychloroquine versus MTX Plus Leflunomide in Patients with MTX-Resistant Active Rheumatoid Arthritis: A 2-Year Cohort Study in Real World. J Inflamm Res 2020; 13:1141-1150. [PMID: 33376379 PMCID: PMC7755368 DOI: 10.2147/jir.s282249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the efficacy, safety, and cost-effectiveness of methotrexate (MTX) plus hydroxychloroquine (HCQ) vs MTX plus leflunomide (LEF) in established rheumatoid arthritis (RA) with inadequate response to MTX monotherapy in a real-world Chinese cohort. Patients and Methods A prospective RA cohort (n=549) was screened with eligible patients who had inadequate response (disease activity score in 28 joints using erythrocyte sedimentation rate, DAS28-ESR>3.2) to initial MTX monotherapy and subsequently received either MTX+HCQ or MTX+LEF. Propensity score matching (PSM) was applied to adjust the possible baseline confounders between two groups. The primary outcome was the proportion of patients achieving first remission (DAS28-ESR<2.6) during follow-up by log rank test. Secondary outcomes were changes of DAS28, glucocorticoids (GCs) exposure, safety, cost-effectiveness, sustained remission, and low disease activity (LDA) rate after 24-month follow-up. Results Overall, 222 eligible patients were subjected to the aforementioned two treatment protocols (MTX+HCQ, n=102; MTX+LEF, n=120). After PSM adjustment, 97 patients in each group were analyzed. A higher remission rate was observed in the MTX+HCQ group than in the MTX+LEF group (70.1% vs 56.7%, P=0.048). The median time to remission was 11 and 16 months in the two groups, respectively. At the endpoint, more patients achieved remission (46.8% vs 32.5%, P=0.063) and maintained sustained LDA in the HCQ group (53.2% vs 38.6%, P=0.062) and also more patients withdrew GCs in this group (32% vs 16.7%, P=0.053) than those in the LEF group. Safety profiles were non-alarming, with no significant difference between the two groups. The incremental cost-effectiveness ratio yielded by MTX+HCQ over MTX+LEF was $1,111.8 per quality-adjusted life-year (QALY), within the cost-effective threshold set as the per capita gross domestic product (GDP) of China. Conclusion The MTX+HCQ combination was seemingly superior to MTX+LEF in a real-world cohort of Chinese RA patients with inadequate response to methotrexate monotherapy in respect of the efficacy and cost-effectiveness.
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Affiliation(s)
- Le Zhang
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.,Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Fangfang Chen
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shikai Geng
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaodong Wang
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Liyang Gu
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yitian Lang
- Department of Pharmacy, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Ting Li
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shuang Ye
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Onsun N, Güneş B, Yabacı A. Retention and survival rate of etanercept in psoriasis over 15 years and patient outcomes during the COVID-19 pandemic: The real-world experience of a single center. Dermatol Ther 2020; 34:e14623. [PMID: 33274541 PMCID: PMC7744860 DOI: 10.1111/dth.14623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
There have been a number of investigations of the efficacy and safety of etanercept. This study was performed to obtain long‐term drug survival data (ie, time to drug discontinuation) for etanercept, and the reasons for its discontinuation. The study population consisted of patients with psoriatic arthritis and psoriasis followed up by our clinic, registered in the Turkish Psoriasis Registry (PSR‐TR) and treated with etanercept for at least 4 weeks between January 1, 2005, and January 31, 2020. The efficacy of etanercept was evaluated in terms of the Psoriasis Area and Severity Index (PASI) 75, PASI 90 and PASI 100 response rates at 12, 24, 36, and 48 weeks, and annually thereafter. The behaviors of the patients with respect to the use of etanercept, and the outcomes of those who continued to use it during the COVID‐19 pandemic, were also investigated.
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Affiliation(s)
- Nahide Onsun
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Begüm Güneş
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayşegül Yabacı
- Department of Bioistatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Provenzano G, Arcuri C, Miceli MC. Open-label non-mandatory transitioning from originators to biosimilars in routine clinical care. Clin Rheumatol 2020; 40:425-427. [PMID: 32776313 DOI: 10.1007/s10067-020-05327-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/19/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe Provenzano
- Rheumatology Unit, "Villa Sofia - Cervello" Hospital, via del Fante, 90144, Palermo, Italy.
| | - Chiara Arcuri
- Rheumatology Unit, "Villa Sofia - Cervello" Hospital, via del Fante, 90144, Palermo, Italy
| | - Maria Concetta Miceli
- Rheumatology Unit, "Villa Sofia - Cervello" Hospital, via del Fante, 90144, Palermo, Italy
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Fleischmann R, Jairath V, Mysler E, Nicholls D, Declerck P. Nonmedical Switching From Originators to Biosimilars: Does the Nocebo Effect Explain Treatment Failures and Adverse Events in Rheumatology and Gastroenterology? Rheumatol Ther 2020; 7:35-64. [PMID: 31950442 PMCID: PMC7021884 DOI: 10.1007/s40744-019-00190-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
The act of nonmedical switching, defined as switching stable patients who are generally doing well with their current therapy from an originator biologic to its biosimilar, has been endorsed as a reasonable treatment strategy. The safety and efficacy of nonmedical switching have been evaluated in randomized controlled and real-world evidence studies, which have demonstrated that although many patients maintain treatment response after the switch, some patients experience therapy failure, resulting in therapy discontinuation. It has been postulated that the vast majority, if not all, of these treatment failures result from a "nocebo effect", defined as patients' negative expectations toward the therapy change. Reports suggest that the risk of a nocebo effect is higher following a mandated nonmedical switch. Although the nocebo effect is a well-recognized phenomenon in pain studies, evidence is limited in immune-mediated diseases primarily because it is difficult to quantify, especially retrospectively. In spite of this, numerous biosimilar studies in patients with immune-mediated diseases have concluded that nonmedical switching failures are due to a nocebo effect. The objective of this narrative review was to explore the reasons for nonmedical switch failure or discontinuation and the role of the nocebo effect among patients with inflammatory rheumatic and gastrointestinal diseases who switched from an originator biologic to its biosimilar.
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Affiliation(s)
- Roy Fleischmann
- University of Texas Southwestern Medical Center, Metropleac Clinical Research Center, 8144 Walnut Hill Lane, Dallas, TX, 75231, USA.
| | - Vipul Jairath
- Division of Gastroenterology, Departments of Medicine, Epidemiology and Biostatistics, University Hospital, Western University, Room A10-228, London, ON, Canada
| | - Eduardo Mysler
- Organización Médica de Investigación, Callao 384 Piso 2 Dto 6, CABA, C1022AAQ, Buenos Aires, Argentina
| | - Dave Nicholls
- Coast Joint Care, University of the Sunshine Coast, Maroochy Waters Shopping Centre, Denna Street, Maroochydore, QLD, 4558, Australia
| | - Paul Declerck
- University of Leuven, Campus Gasthuisberg O&N 2, Herestraat 49, P.B. 820, 3000, Leuven, Belgium
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Khraishi M, Ivanovic J, Zhang Y, Millson B, Brabant MJ, Woolcott J, Jones H, Curiale C. Real-world utilization of methotrexate or prednisone co-therapy with etanercept among Canadian patients with rheumatoid arthritis: a retrospective cohort study. Curr Med Res Opin 2019; 35:2025-2033. [PMID: 31237785 DOI: 10.1080/03007995.2019.1636543] [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: 10/26/2022]
Abstract
Objective: To evaluate whether initiation of etanercept therapy among patients with rheumatoid arthritis (RA) impacts use of co-therapy with methotrexate or prednisone, and to describe etanercept dosing dynamics compared to product monograph in the Canadian real-world setting. Methods: A retrospective cohort study was conducted using claims-level data from IQVIA Private Drug Plan database, Ontario Public Drug Plan database and Régie de l'assurance maladie du Québec database. Bio-naïve RA patients initiating etanercept between July 2014 and June 2015 were identified and their claims for methotrexate or prednisone were analyzed. Utilization of methotrexate or prednisone was calculated as average weekly dose in milligrams, and compared in the 6 months pre-initiation versus 12 months post-initiation of etanercept. Weekly etanercept dosing of each patient was calculated and analyzed to determine whether patients had at least 20% higher or lower average dose than monograph recommended dose (50 mg/week), and were then flagged as above-monograph or below-monograph, respectively. Results: A total of 2876 patients with RA (66% female, 76% aged 18-65) were included; 62% (n = 1,140) used methotrexate and 27% used prednisone (n = 498) both pre- and post-initiation of etanercept. In methotrexate patients, the average weekly dose dispensed was 25.4 mg in the 6 months pre-etanercept, and 25.0 mg in the 12 months post-etanercept initiation (p = .5282). In prednisone patients, the average weekly dose dispensed reduced from 122.6 mg pre-etanercept to 107.1 mg post-etanercept initiation (p = .2173). Among patients who were already on methotrexate or prednisone, after initiating on etanercept 16% (n = 213) and 34% (n = 254) of patients stopped methotrexate and prednisone, respectively. When compared to the recommended dose, 12% (n = 168) of patients were below-monograph and 7.1% of patients were above-monograph during their first year of etanercept therapy. Average etanercept dosing was consistently lower than product monograph during the follow-up year. Conclusions: Patients had a modest but not statistically significant decrease in prescribed doses of co-therapy with methotrexate and prednisone when etanercept was added to patients' therapy. In addition, 12-14% of patients stopped their co-therapy with methotrexate or prednisone. Further study is needed to understand the impact on patient outcomes and safety.
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Affiliation(s)
- Majed Khraishi
- Faculty of Medicine, Memorial University of Newfoundland , St. Johns , NL , USA
| | | | - Yvonne Zhang
- Health Access and Outcomes, IQVIA , Kanata , ON , USA
| | - Brad Millson
- Health Access and Outcomes, IQVIA , Kanata , ON , USA
| | | | - John Woolcott
- Health Economics and Outcomes Research, Pfizer Inc. , Collegeville , PA , USA
| | - Heather Jones
- Inflammation and Immunology, Global Medical Affairs, Pfizer Inc. , Collegeville , PA , USA
| | - Cinzia Curiale
- Inflammation and Immunology, IDM Region Medical Affairs , Roma , Italy
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Khraishi M, Millson B, Woolcott J, Jones H, Marshall L, Ruperto N. Reduction in the utilization of prednisone or methotrexate in Canadian claims data following initiation of etanercept in pediatric patients with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:64. [PMID: 31500631 PMCID: PMC6734296 DOI: 10.1186/s12969-019-0358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In adult patients with arthritis, use of the tumor necrosis factor (TNF) inhibitor etanercept (ETN) is often associated with a reduction in the utilization of co-medications, particularly steroids. Comparatively little is known about the utilization of co-medications when ETN is initiated in pediatric patients with juvenile idiopathic arthritis (JIA). METHODS This study analyzed Canadian longitudinal claims level data spanning January 2007 to April 2017. Data were collated from the IQVIA Private Drug Plan, Ontario Public Drug Plan, and the Quebec Public Drug Plan (Régie de l'assurance maladie du Québec) databases. Patients < 18 years of age were indexed when filling a prescription for ETN between January 2008 and January 2016. Those who met the inclusion and exclusion criteria were assessed for methotrexate (MTX), and prednisone (PRD) use in the 6 months prior to and 12 months following initiation of ETN. RESULTS Longitudinal claims data for 330 biologic-naive pediatric patients initiating ETN therapy were included. The majority of patients were female (67%), aged 10-17 years (64%), and with a drug history consistent with JIA (96%). Most patients were from Quebec (36%) or Ontario (33%). Dosing of ETN was weight-based with a mean dosage over the first year of 31 mg per week. ETN dosing was relatively consistent over the first year. In total, 222 (67%) patients did not use MTX and 223 (68%) did not use PRD before or after starting ETN. A total of 17% (18/103) of MTX-treated and 50% (46/92) of PRD-treated patients discontinued use of those medications upon initiation of ETN treatment. In patients continuing MTX or PRD, significant reductions in the weekly dosage from 14.3 to 6.8 mg per week for MTX and from 56 to 23 mg per week for PRD were observed (P < 0.01). CONCLUSIONS This study of Canadian claims-level data is the first large prespecified analysis of co-medication utilization following the initiation of ETN therapy in pediatric patients. A decline in both MTX and PRD use and dosage was observed and may be associated with benefits related to safety, tolerability, and overall healthcare costs.
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Affiliation(s)
- Majed Khraishi
- 0000 0000 9130 6822grid.25055.37Memorial University of Newfoundland, St. Johns, NL Canada
| | | | - John Woolcott
- 0000 0000 8800 7493grid.410513.2Global Outcomes and Evidence, Pfizer, Collegeville, PA USA
| | - Heather Jones
- 0000 0000 8800 7493grid.410513.2Global Medical Affairs, Pfizer, Collegeville, PA USA
| | - Lisa Marshall
- 0000 0000 8800 7493grid.410513.2Global Medical Affairs, Pfizer, Collegeville, PA USA
| | - Nicolino Ruperto
- IRCCS, Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia - PRINTO, Genoa, Italy.
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