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Breitman M, Bonfield TL, Caplan AI, Lazarus HM, Haghiac M, LaSalvia S, Reese-Koc J, Singer NG. Optimization of Human Mesenchymal Stem Cells for Rheumatoid Arthritis: Implications for Improved Therapeutic Outcomes. ACR Open Rheumatol 2021; 4:152-160. [PMID: 34792869 PMCID: PMC8843759 DOI: 10.1002/acr2.11356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/13/2021] [Accepted: 09/13/2021] [Indexed: 11/06/2022] Open
Abstract
Objective Seropositive rheumatoid arthritis (RA) is a chronic autoimmune disease that is rarely “cured.” Human mesenchymal stem cells (hMSCs) are known to reduce inflammation and restore immune homeostasis. However, methods for predicting therapeutic hMSC potency have not been established. The goal of these studies was to use and refine an ex vivo functional assay that determines potency of hMSCs and can then be validated in clinical trials as a potency measure of hMSCs used therapeutically to treat RA. Methods Allogeneic hMSCs were cytokine‐stimulated, and a conditioned medium (CM) was harvested. The CM was tested for the potential to attenuate RA CD4+ T cell proliferation using suppression assays. Indoleamine 2, 3‐dioxygenase (IDO) mRNA, and protein were quantified in hMSCs as a measure to compare hMSCs across (prior) studies. Results To mimic a proinflammatory environment that resembles that in RA, interleukin‐1(IL1β), tumor necrosis factor α (TNFα), and interferon γ (IFNγ) (alone or in combination) were used to precondition hMSCs. Treating hMSCs with a combination of these cytokines generated a CM “secretome” that suppressed T cell proliferation between 70 and 83%. Forty‐eight hours of cytokine preconditioning hMSCs was required to maximize this effect. T cell suppression positively correlated with increases in hMSC cellular IDO mRNA and protein. Conclusion By standardizing assays to measure hMSC effects, their potency on T cell suppression can be quantified. These studies demonstrate that hMSCs can be compared functionally to identify optimal preparation(s) for therapeutic use in RA and that the potency of hMSC‐dependent T cell suppression may differ between hMSC donors. Clinical studies are warranted to validate the hypothesis that ex vivo potency in suppressing T cells will positively correlate with a reduction in RA disease activity and increase in immunological quiescence.
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Affiliation(s)
- Maya Breitman
- Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio, USA
| | | | | | | | | | | | | | - Nora G Singer
- Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio, USA
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Karpes Matusevich AR, Duan Z, Zhao H, Lal LS, Chan W, Suarez-Almazor ME, Giordano SH, Swint JM, Lopez-Olivo MA. Treatment Sequences After Discontinuing a Tumor Necrosis Factor Inhibitor in Patients With Rheumatoid Arthritis: A Comparison of Cycling Versus Swapping Strategies. Arthritis Care Res (Hoboken) 2021; 73:1461-1469. [PMID: 32558339 DOI: 10.1002/acr.24358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the sequences of tumor necrosis factor inhibitors (TNFi) and non-TNFi used by rheumatoid arthritis (RA) patients whose initial TNFi therapy has failed, and to evaluate effectiveness and costs. METHODS Using the Truven Health MarketScan Research database, we analyzed claims of commercially insured adult patients with RA who switched to their second biologic or targeted disease-modifying antirheumatic drug between January 2008 and December 2015. Our primary outcome was the frequency of treatment sequences. Our secondary outcomes were the time to therapy discontinuation, drug adherence, and drug and other health care costs. RESULTS Among 10,442 RA patients identified, 36.5% swapped to a non-TNFi drug, most commonly abatacept (54.2%). The remaining 63.5% cycled to a second TNFi, most commonly adalimumab (41.2%). For subsequent switches of therapy, non-TNFi were more common. Patients who swapped to a non-TNFi were significantly older and had more comorbidities than those who cycled to a TNFi (P < 0.001). Survival analysis showed a longer time to discontinuation for non-TNFi than for TNFi (median 605 days compared with 489 days; P < 0.001) when used after initial TNFi discontinuation, but no difference in subsequent switches of therapy. Although non-TNFi were less expensive for adherent patients, cycling to a TNFi was associated with lower costs overall. CONCLUSION Even though patients are more likely to cycle to a second TNFi than swap to a non-TNFi, those who swap to a non-TNFi are more likely to persist with the therapy. However, cycling to a TNFi is the less costly strategy.
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Affiliation(s)
| | - Zhigang Duan
- The University of Texas MD Anderson Cancer Center, Houston
| | - Hui Zhao
- The University of Texas MD Anderson Cancer Center, Houston
| | - Lincy S Lal
- School of Public Health, The University of Texas Health Science Center at Houston
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston
| | | | | | - J Michael Swint
- School of Public Health and McGovern School of Medicine, The University of Texas Health Science Center at Houston
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Karpes Matusevich AR, Suarez‐Almazor ME, Cantor SB, Lal LS, Swint JM, Lopez‐Olivo MA. Systematic Review of Economic Evaluations of Cycling Versus Swapping Medications in Patients With Rheumatoid Arthritis After Failure to Respond to Tumor Necrosis Factor Inhibitors. Arthritis Care Res (Hoboken) 2020; 72:343-352. [DOI: 10.1002/acr.23859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 02/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Aliza R. Karpes Matusevich
- University of Texas MD Anderson Cancer Center and Houston School of Public HealthUniversity of Texas Health Science Center at Houston
| | | | | | - Lincy S. Lal
- School of Public HealthUniversity of Texas Health Science Center at Houston
| | - J. Michael Swint
- School of Public Health and McGovern School of MedicineUniversity of Texas Health Science Center at Houston
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Muszbek N, Proudfoot C, Fournier M, Chen CI, Kuznik A, Kiss Z, Gal P, Michaud K. Cost-Effectiveness of Sarilumab Added to Methotrexate in the Treatment of Adult Patients with Moderately to Severely Active Rheumatoid Arthritis Who Have Inadequate Response or Intolerance to Tumor Necrosis Factor Inhibitors. J Manag Care Spec Pharm 2019; 25:1268-1280. [PMID: 31663465 PMCID: PMC10397978 DOI: 10.18553/jmcp.2019.25.11.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite a substantial number of treatment options in rheumatoid arthritis (RA) following tumor necrosis factor inhibitor (TNFi) inadequate response or intolerance (TNF-IR), a lack of clarity on the optimal approach remains. Sarilumab, a human monoclonal anti-interleukin-6 receptor alpha antibody, can be used as monotherapy or in combination with methotrexate or other conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) in TNF-IR patients. OBJECTIVE To conduct a cost-utility analysis from a U.S. health care system perspective for sarilumab subcutaneous 200 mg + methotrexate versus abatacept + methotrexate or a bundle of TNFi + methotrexate for treatment of adult patients with moderately to severely active RA and TNF-IR. METHODS Analysis was conducted via individual patient simulation based on patient profiles from the TARGET trial (NCT01709578); a 6-month decision tree was followed by lifetime semi-Markov model with 6-month cycles. Treatment response at 6 months, informed by network meta-analysis, was based on American College of Rheumatology (ACR) 20/50/70 criteria; patients achieving ≥ ACR20 continued with current therapy, and other patients moved to the next line of biologic DMARD therapy or conventional synthetic DMARD palliative treatment. Direct costs included wholesale acquisition drug costs and administration and routine care costs. Routine care costs and quality-adjusted life-years (QALYs) were estimated by predicting the Health Assessment Questionnaire Disability Index score based on treatment response and were imputed from published equations. RESULTS Sarilumab + methotrexate dominated the TNFi bundle + methotrexate, achieving lower costs ($319,324 vs. $356,096) and greater effectiveness (4.27 vs. 4.15 QALYs), and was on the cost-efficiency frontier with abatacept + methotrexate ($360,211 and 4.29 QALYs). Abatacept + methotrexate was not cost-effective versus sarilumab + methotrexate. Scenario analyses indicated the results were robust; sarilumab + methotrexate became dominant against abatacept + methotrexate after reduced model horizon, minimum response based on ACR50 or ACR70, or time to discontinuation per treatment class. Sarilumab + methotrexate was also dominant versus the TNFi bundle; when class-specific time to treatment discontinuation was specified, sarilumab remained cost-effective with an incremental cost-effectiveness ratio of $36,894. CONCLUSIONS Sarilumab + methotrexate can be considered an economically dominant (more effective, less costly) option versus a second TNFi + methotrexate; compared with abatacept + methotrexate, it is a less costly but less effective option for patients with moderately to severely active RA who have previously failed TNFi. DISCLOSURES This study was funded by Sanofi and Regeneron Pharmaceuticals. Kiss and Gal are employees of Evidera, which received consulting fees from Sanofi/Regeneron for conducting this study. Muszbek was employed by Evidera at the time of this study. Kuznik and Chen are current employees of and stockholders in Regeneron Pharmaceuticals. Fournier is an employee of and stockholder in Sanofi. Proudfoot is a former employee of and current stockholder in Sanofi and current employee and stockholder in ViiV Healthcare/GlaxoSmithKline. Michaud has received grant funding from Pfizer and the Rheumatology Research Foundation. The sponsors were involved in the study design, collection, analysis, and interpretation of data as well as data checking of information provided in the manuscript. The authors had unrestricted access to study data, were responsible for all content and editorial decisions, and received no honoraria related to the development of this publication.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antirheumatic Agents/economics
- Antirheumatic Agents/therapeutic use
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/economics
- Cost-Benefit Analysis
- Decision Trees
- Drug Therapy, Combination/economics
- Drug Therapy, Combination/methods
- Female
- Humans
- Male
- Methotrexate/economics
- Methotrexate/therapeutic use
- Middle Aged
- Models, Economic
- Severity of Illness Index
- Treatment Outcome
- Tumor Necrosis Factor Inhibitors/economics
- Tumor Necrosis Factor Inhibitors/therapeutic use
- Young Adult
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Affiliation(s)
| | | | | | | | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
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Vanderpoel J, Tkacz J, Brady BL, Ellis L. Health Care Resource Utilization and Costs Associated With Switching Biologics in Rheumatoid Arthritis. Clin Ther 2019; 41:1080-1089.e5. [DOI: 10.1016/j.clinthera.2019.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/07/2019] [Accepted: 04/18/2019] [Indexed: 11/30/2022]
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Shahabi A, Shafrin J, Zhao L, Green S, Curtice T, Marshall A, Paul D. The economic burden of switching targeted disease-modifying anti-rheumatic drugs among rheumatoid arthritis patients. J Med Econ 2019; 22:350-358. [PMID: 30653389 DOI: 10.1080/13696998.2019.1571498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS To estimate real world healthcare costs and resource utilization of rheumatoid arthritis (RA) patients associated with targeted disease modifying anti-rheumatic drugs (tDMARD) switching in general and switching to abatacept specifically. MATERIALS AND METHODS RA patients initiating a tDMARD were identified in IMS PharMetrics Plus health insurance claims data (2010-2016), and outcomes measured included monthly healthcare costs per patient (all-cause, RA-related) and resource utilization (inpatient stays, outpatient visits, emergency department [ED] visits). Generalized linear models were used to assess (i) average monthly costs per patient associated with tDMARD switching, and (ii) among switchers only, costs of switching to abatacept vs tumor necrosis factor inhibitors (TNFi) or other non-TNFi. Negative binomial regressions were used to determine incident rate ratios of resource utilization associated with switching to abatacept. RESULTS Among 11,856 RA patients who initiated a tDMARD, 2,708 switched tDMARDs once and 814 switched twice (to a third tDMARD). Adjusted average monthly costs were higher among patients who switched to a second tDMARD vs non-switchers (all-cause: $4,785 vs $3,491, p < .001; RA-related: $3,364 vs $2,297, p < .001). Monthly RA-related costs were higher for patients switching to a third tDMARD compared to non-switchers remaining on their second tDMARD ($3,835 vs $3,383, p < .001). Switchers to abatacept had significantly lower RA-related monthly costs vs switchers to TNFi ($3,129 vs $3,436, p = .021), and numerically lower all-cause costs ($4,444 vs $4,741, p = 0.188). Switchers to TNFi relative to abatacept had more frequent inpatient stays after switch (incidence rate ratio (IRR) = 1.85, p = .031), and numerically higher ED visits (IRR = 1.32, p = .093). Outpatient visits were less frequent for TNFi switchers (IRR = 0.83, p < .001) compared to switchers to abatacept. LIMITATIONS AND CONCLUSIONS Switching to another tDMARD was associated with higher healthcare costs. Switching to abatacept, however, was associated with lower RA-related costs, fewer inpatient stays, but more frequent outpatient visits compared to switching to a TNFi.
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Affiliation(s)
- Ahva Shahabi
- a Precision Health Economics , Los Angeles , CA 90025 , USA
| | - Jason Shafrin
- a Precision Health Economics , Los Angeles , CA 90025 , USA
| | - Lauren Zhao
- a Precision Health Economics , Los Angeles , CA 90025 , USA
| | - Sarah Green
- a Precision Health Economics , Los Angeles , CA 90025 , USA
| | - Tammy Curtice
- b Bristol-Myers Squibb , Lawrenceville , NJ 08648 , USA
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Arayssi T, Harfouche M, Darzi A, Al Emadi S, A Alnaqbi K, Badsha H, Al Balushi F, Dib C, Elzorkany B, Halabi H, Hammoudeh M, Hazer W, Masri B, Merashli M, Omair M, Salloum N, Uthman I, Zahirovic S, Ziade N, Bannuru RR, McAlindon T, Nomier MA, Singh JA, Christensen R, Tugwell P, Schünemann H, Akl EA. Recommendations for the management of rheumatoid arthritis in the Eastern Mediterranean region: an adolopment of the 2015 American College of Rheumatology guidelines. Clin Rheumatol 2018; 37:2947-2959. [PMID: 30097896 DOI: 10.1007/s10067-018-4245-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/25/2018] [Indexed: 12/20/2022]
Abstract
Clinical practice guidelines can assist rheumatologists in the proper prescription of newer treatment for rheumatoid arthritis (RA). The objective of this paper is to report on the recommendations for the management of patients with RA in the Eastern Mediterranean region. We adapted the 2015 American College of Rheumatology guidelines in two separate waves. We used the adolopment methodology, and followed the 18 steps of the "Guidelines 2.0" comprehensive checklist for guideline development. For each question, we updated the original guidelines' evidence synthesis, and we developed an Evidence Profile (EP) and an Evidence to Decision (EtD) table. In the first wave, we adoloped eight out of the 15 original questions on early RA. The strength changed for five of these recommendations from strong to conditional, due to one or more of the following factors: cost, impact on health equities, the balance of benefits, and harms and acceptability. In the second wave, we adoloped eight out of the original 44 questions on established RA. The strength changed for two of these recommendations from strong to conditional, in both cases due to cost, impact on health equities, balance of benefits and harms, and acceptability. The panel also developed a good practice recommendation. We successfully adoloped 16 recommendations for the management of early and established RA in the Eastern Mediterranean region. The process proved feasible and sensitive to contextual factors.
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Affiliation(s)
- Thurayya Arayssi
- Department of Internal Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Andrea Darzi
- Faculty of Health Sciences, AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Samar Al Emadi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Khalid A Alnaqbi
- Department of Rheumatology, Medical Institute, Al Ain Hospital, Al Ain, United Arab Emirates
| | - Humeira Badsha
- Dr. Humeira Badsha Medical Center, Emirates Hospital, Dubai, United Arab Emirates
| | | | - Carole Dib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Hussein Halabi
- Rheumatology Division, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Wissam Hazer
- Nursing Department, Aspetar Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Basel Masri
- Department of Internal Medicine, Jordan Hospital, Amman, Jordan
| | - Mira Merashli
- Department of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Omair
- Division of Rheumatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nelly Salloum
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Department of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sumeja Zahirovic
- Department of Internal Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Nelly Ziade
- Faculty of Medicine, Univeristé Saint Joseph, Beirut, Lebanon
| | - Raveendhara R Bannuru
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA
| | - Timothy McAlindon
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA
| | - Mohamed A Nomier
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, USA.,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon. .,Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, ON, Canada. .,AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
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Kay AG, Long G, Tyler G, Stefan A, Broadfoot SJ, Piccinini AM, Middleton J, Kehoe O. Mesenchymal Stem Cell-Conditioned Medium Reduces Disease Severity and Immune Responses in Inflammatory Arthritis. Sci Rep 2017; 7:18019. [PMID: 29269885 PMCID: PMC5740178 DOI: 10.1038/s41598-017-18144-w] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/05/2017] [Indexed: 12/29/2022] Open
Abstract
We evaluated the therapeutic potential of mesenchymal stem cell-conditioned medium (CM-MSC) as an alternative to cell therapy in an antigen-induced model of arthritis (AIA). Disease severity and cartilage loss were evaluated by histopathological analysis of arthritic knee joints and immunostaining of aggrecan neoepitopes. Cell proliferation was assessed for activated and naïve CD4+ T cells from healthy mice following culture with CM-MSC or co-culture with MSCs. T cell polarization was analysed in CD4+ T cells isolated from spleens and lymph nodes of arthritic mice treated with CM-MSC or MSCs. CM-MSC treatment significantly reduced knee-joint swelling, histopathological signs of AIA, cartilage loss and suppressed TNFα induction. Proliferation of CD4+ cells from spleens of healthy mice was not affected by CM-MSC but reduced when cells were co-cultured with MSCs. In the presence of CM-MSC or MSCs, increases in IL-10 concentration were observed in culture medium. Finally, CD4+ T cells from arthritic mice treated with CM-MSC showed increases in FOXP3 and IL-4 expression and positively affected the Treg:Th17 balance in the tissue. CM-MSC treatment reduces cartilage damage and suppresses immune responses by reducing aggrecan cleavage, enhancing Treg function and adjusting the Treg:Th17 ratio. CM-MSC may provide an effective cell-free therapy for inflammatory arthritis.
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Affiliation(s)
- Alasdair G Kay
- Biology Department, University of York, Wentworth Way, York, UK.,ISTM at RJAH Orthopaedic Hospital, Keele University, Oswestry, UK
| | - Grace Long
- School of Medicine, Keele University, Staffordshire, UK
| | - George Tyler
- School of Medicine, Keele University, Staffordshire, UK
| | - Andrei Stefan
- ISTM at RJAH Orthopaedic Hospital, Keele University, Oswestry, UK
| | | | | | - Jim Middleton
- Faculty of Health Sciences, School of Oral and Dental Science, University of Bristol, Bristol, UK
| | - Oksana Kehoe
- ISTM at RJAH Orthopaedic Hospital, Keele University, Oswestry, UK.
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Li N, Betts KA, Messali AJ, Skup M, Garg V. Real-world Effectiveness of Biologic Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis After Etanercept Discontinuation in the United Kingdom, France, and Germany. Clin Ther 2017; 39:1618-1627. [DOI: 10.1016/j.clinthera.2017.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
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10
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Husni ME, Betts KA, Griffith J, Song Y, Ganguli A. Benefit-risk trade-offs for treatment decisions in moderate-to-severe rheumatoid arthritis: focus on the patient perspective. Rheumatol Int 2017. [PMID: 28623526 DOI: 10.1007/s00296-017-3760-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Given the increasing number of available treatments for rheumatoid arthritis (RA) with varying efficacy and safety profiles, it is critical to understand the level of trade-offs that patients are willing to make between benefits and risks. Adult patients with moderate to severe RA were invited to participate in a discrete choice experiment that solicited their preferences for hypothetical RA treatments. Each participant was presented with 14 choice cards asking about their preference between two hypothetical RA treatments with varying levels of efficacy, adverse events, and process-related attributes. A multivariable logistic regression model assessed the association between the attributes and the patient's decision and risk-increases were calculated. 510 eligible patients with moderate to severe RA completed the study. The average age of the participants was 56.4 years, 64.7% were female, and 45.1% received biologic agents. To achieve a 50% improvement in physical function, patients were willing to accept risk-increases of 91.1, 4.7, and 18.4% for abnormal laboratory results, cancer, and serious infection, respectively. Similarly, to achieve a 50% reduction in RA-related pain, patients were willing to accept risk-increases of 70.6, 3.7, and 14.2% for each AE. Moreover, patients were willing to trade risk-increases of 42.0, 2.2, and 8.5% for each AE to obtain a 50% reduction in the number of swollen joints. Patients with moderate to severe RA are willing to accept increased treatment risks to achieve improved physical function and disease control. These attributes are helpful to clinicians to make informed treatment choices.
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Affiliation(s)
| | - Keith A Betts
- Analysis Group, Inc., 333 S. Hope Street, 27th Floor, Los Angeles, CA, USA.
| | | | - Yan Song
- Analysis Group, Inc., Boston, MA, USA
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