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Peasah SK, Swart ECS, Huang Y, Kane-Gill SL, Seybert AL, Patel U, Manolis C, Good CB. Disease-Modifying Medications in Patients with Rheumatoid Arthritis in the USA: Trends from 2016 to 2021. Drugs Real World Outcomes 2024; 11:241-249. [PMID: 38368583 PMCID: PMC11176124 DOI: 10.1007/s40801-024-00416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Disease-modifying anti-rheumatic drugs (DMARDs), since their introduction in 1990, have revolutionized the management of rheumatoid arthritis. Newer DMARDs have recently been approved, influencing treatment patterns and clinical guidelines. OBJECTIVE To update the current prescribing patterns of DMARDs in the pharmacotherapy of rheumatoid arthritis (RA) to include the pandemic era. METHODS This was a retrospective cross-sectional multi-year study. Using Optum's Clinformatics® Data Mart Database, we summarized trends in the prevalence of DMARD use in the USA from 2016 to 2021 by year for adult patients ≥ 18 years old with at least one medical RA claim and one pharmacy/medical claim of a DMARD medication. Trends included type of DMARD, class of DMARD (conventional (csDMARDs), biologics [tumor necrosis factor (TNFi) and Non-TNFi), and Janus kinase inhibitors (JAKs)], and triple therapy [methotrexate (MTX), hydroxychloroquine (HCQ), sulfasalazine (SUL)] used. RESULTS The total sample from 2016 to 2021 was 670,679 commercially insured patients. The average age was 63.7 years (SD 13.6), and 76.7% were female and 70% were White. csDMARDs remain the most prescribed (ranging from 77.2 to 79.2%). Although JAKs were the least prescribed DMARD class, their proportion more than doubled from 2016 (1.5%) to 2021 (4%). MTX utilization declined from 40% in 2016 to 34% in 2021. In contrast, HCQ use increased during the pandemic era from < 25% in 2018 to 30% in 2021. Although there is evidence of the therapeutic benefit of triple therapy, its use was very low (~ 1%) compared to biologics only (~ 17%) or biologics+MTX (~ 10%). CONCLUSION About half of patients with RA were on DMARDs. As expected, csDMARDs were highly used consistently. The COVID-19 pandemic might have influenced the use of HCQ and infusion DMARDs. Triple therapy use remains low.
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Affiliation(s)
- Samuel K Peasah
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA.
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Elizabeth C S Swart
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA
| | - Yan Huang
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA
| | | | - Amy L Seybert
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Urvashi Patel
- Evernorth Research Institute, Cigna Health, St. Louis, MO, USA
| | - Chronis Manolis
- Department of Pharmacy, UPMC Health Plan, Pittsburgh, PA, USA
| | - Chester B Good
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacy, UPMC Health Plan, Pittsburgh, PA, USA
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Miranda EM, Han X, Park SH, Suri S, Suryavanshi M. Treatment Patterns Among Patients with Rheumatoid Arthritis in Puerto Rico. Rheumatol Ther 2022; 9:609-619. [PMID: 35076904 PMCID: PMC8964873 DOI: 10.1007/s40744-021-00408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/23/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Racial and ethnic disparities in rheumatoid arthritis (RA) have been identified in the United States, with higher levels of disease activity and worse functional status reported in Hispanic patients compared with their white counterparts. Although RA is one of the most prevalent health conditions in Puerto Rico, few studies have previously examined the characteristics or treatment patterns of patients receiving biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in this population. Methods This was a retrospective cohort study using data extracted from the Advanced Business Management Organization database, which represents around 70% of pharmacy claims in Puerto Rico. Patients with RA were included if they had ≥ 1 prescription for any approved b/tsDMARD during the index period (January 2016 to July 2018), and ≥ 2 years of follow-up. The objective was to describe and compare the demographic and clinical characteristics of patients with RA being treated with b/tsDMARD therapy in Puerto Rico, and to evaluate the treatment patterns among these patients. Results Most patients (74%) received tumor necrosis factor inhibitors (TNFis) as index therapy, followed by abatacept (17%), Janus kinase inhibitors (JAKis; 5%), and other non-TNFis (4%). Similar trends were observed in subsequent lines of therapy, although abatacept was more frequently used in these later lines versus index therapy. At 2 years, 62% of patients had discontinued their index therapy and 17% had switched to an alternative b/tsDMARD; only 21% persisted with index therapy. The percentage of patients who were persistent with their index therapy at the end of year 2 was 28% for JAKis, 36% for abatacept, 41% for TNFis, and 45% for other non-TNFis. Conclusions These findings demonstrate that despite the availability of several b/tsDMARDs, patients with RA in Puerto Rico still experience substantial treatment disruption, with almost two-thirds of patients discontinuing their index therapy within 2 years. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00408-7.
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Affiliation(s)
| | - Xue Han
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Sang Hee Park
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Sonick Suri
- Mu Sigma Inc, No 3400, Dundee Rd, Suite 160, Northbrook, IL, USA
| | - Manasi Suryavanshi
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA.
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Paula M, Vappu R, Hannu K, Juhani VL, Kari P. Opioid use frequency in early axial spondyloarthritis in Finland - a pharmacoepidemic register study. Joint Bone Spine 2021; 89:105302. [PMID: 34687895 DOI: 10.1016/j.jbspin.2021.105302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/03/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate opioid use among incident axial spondyloarthritis (axSpA) patients compared to general population. METHODS From the national register, we identified all adult patients with axSpA (ICD-10 codes M45-46), who between 2010 and 2014 (index date, ID) were for the first time granted special reimbursement for any disease-modifying anti-rheumatic drugs (DMARDs). Three matched population controls were identified for each patient. Drug purchases were evaluated between 2009-15, and opioid use was analyzed for one year before and after the ID. The Defined Daily Dose (DDD) was used as a tool to assess the opioid consumption before and after the biological (b) DMARD initiation. RESULTS We identified 3,577 axSpA patients and 10,573 controls. Of these patients, 97.2% started a conventional synthetic (cs) DMARD during a year after ID and 23.4% switched later to a self-injected bDMARD between the ID and 31 Dec 2015 (median follow-up 3.4 years). Opioids were purchased at least once by 29.8% and 21.7% of the patients in the years before and after the ID, respectively, compared to 8.1% and 7.8% of the controls. The proportion of opioid-using patients was greatest during the last quarter before the ID [relative risk (RR) 4.72 (95% CI 4.14 to 5.39)] compared to controls, and it remained higher [RR 2.84 (2.59 to 3.11)] also after the start of csDMARDs. DDD of opioid consumption decreased from 7.7 to 1.6/1,000 inhabitants after bDMARD initiation. CONCLUSION Considerably more axSpA patients than population controls used opioids. The opioid consumption by dose decreased clearly after bDMARD initiation.
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Affiliation(s)
- Muilu Paula
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland.
| | - Rantalaiho Vappu
- Department of Internal Medicine, Kanta-Hame Central Hospital, Hameenlinna, Finland; Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kautiainen Hannu
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Virta Lauri Juhani
- Research Department, Social Insurance Institution of Finland, Turku, Finland
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O'Neill KD, Marks KE, Sinicrope PS, Crowson CS, Symons D, Myasoedova E, Davis JM. Importance of Shared Treatment Goal Discussions in Rheumatoid Arthritis-A Cross-Sectional Survey: Patients Report Providers Seldom Discuss Treatment Goals and Outcomes Improve When Goals Are Discussed. ACR Open Rheumatol 2021; 3:870-878. [PMID: 34535987 PMCID: PMC8672176 DOI: 10.1002/acr2.11335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Treat‐to‐target (T2T) and shared decision‐making are valued features of current guidelines for rheumatoid arthritis (RA) management. Although T2T has demonstrated value for improving RA outcomes, implementation remains inconsistent and lacks standardization and procedures for including patient input. We sought to better understand the impact of shared decisions on T2T and how treatment goal discussions between patients and providers impact RA treatment improvement and satisfaction. Methods An anonymous, web‐based questionnaire was presented to United States residents aged 18 years or older with a self‐reported diagnosis of RA by a medical professional with 28 questions regarding socio‐demographics, RA disease activity (DA), diagnosis, treatments, outcomes, and goals. Analyses included descriptive statistics with χ2 and rank sum tests for comparisons. Results The questionnaire was completed by 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female). The majority (571; 63%) did not discuss RA treatment goals with providers. Patients engaging in treatment goal discussions with their providers were three times more likely to be satisfied with their treatment plans. Patients discussing treatment goals with their providers were more likely to have improved DA levels and 68% more likely to reach remission. Conclusion A majority of patients with RA report having no treatment goal discussion with their providers; however, these discussions are associated with greater DA improvement and treatment satisfaction. Further research should seek understanding of how shared treatment goal discussions relate to successful RA management and explore the development of practical tools to implement them in regular clinic practice as part of a T2T regimen.
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Affiliation(s)
| | - Kathryne E Marks
- Rheumatoid Patient Foundation, Lutz, Florida, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Pamela S Sinicrope
- Rheumatoid Patient Foundation, Lutz, Florida, and Mayo Clinic, Rochester, Minnesota
| | | | - Dana Symons
- Rheumatoid Patient Foundation, Lutz, Florida
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Pain Medication and Corticosteroid Use in Ankylosing Spondylitis, Psoriatic Arthritis, and Rheumatoid Arthritis in the United States: A Retrospective Observational Study. Rheumatol Ther 2021; 8:1371-1382. [PMID: 34312825 PMCID: PMC8380595 DOI: 10.1007/s40744-021-00344-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023] Open
Abstract
Objective We compared pain medication use in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) versus matched control over 2 years; a subgroup analysis assessed changes in pain medication use in patients who initiated a biologic during 12 months before and after. Methods This was a retrospective observational cohort study using an administrative claims database. Newly diagnosed adult patients with AS, PsA, or RA identified between 1/1/2014 and 7/31/2017 were included. Demographics, baseline characteristics, and pain medication use were described using descriptive statistics. Differences in pain medication use were assessed using McNemar's/Wilcoxon signed-rank test for categorical/continuous variables. Results The study included 2180 AS, 5681 PsA, and 34,047 RA patients to assess overall pain medication use over 2 years; 188 AS, 921 PsA, and 1599 RA patients were included to assess changes in pain medication use 12 months before and after initiation of biologic. Demographics and baseline characteristics were balanced. In the overall cohort, 74.6% AS, 75.0% PsA, and 83.0% RA patients used any pain medication at baseline versus matched control; pain medications use 2 years after diagnosis date was reported in 73.5% AS, 74.1% PsA, and 81.3% RA patients. Among AS, PsA, and RA patients, use of prescribed NSAIDs (AS: 68.1 vs. 51.1%; PsA: 51.1 vs. 42.5%; RA: 61.1 vs. 41.5%; P < 0.05), glucocorticoids (AS: 56.4 vs. 41.5%; PsA: 57.4 vs. 46.9%; RA: 88.2 vs. 75.3%; P < 0.05), and opioids (AS: 42.6 vs. 36.2% [non-significant]; PsA: 38.1 vs. 33.8%; RA: 52.0 vs. 40.4%; P < 0.05) significantly decreased 12 months after biologic initiation versus prior. Conclusions Use of NSAIDs, glucocorticoids, and opioids are common among patients with AS, PsA, or RA, although the reported use of these co-medications after biologic initiation significantly decreases in the first year of treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00344-6.
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Li KJ, Chang CL, Hsin CY, Tang CH. Switching and Discontinuation Pattern of Biologic Disease-Modifying Antirheumatic Drugs and Tofacitinib for Patients With Rheumatoid Arthritis in Taiwan. Front Pharmacol 2021; 12:628548. [PMID: 34366836 PMCID: PMC8333863 DOI: 10.3389/fphar.2021.628548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/06/2021] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by persistent joint synovial inflammation and swelling, leading to cartilage damage and bone erosion. This retrospective, longitudinal study is to evaluate the treatment patterns of biologic-naïve RA patients receiving index biologic disease-modifying antirheumatic drug (bDMARD) and tofacitinib by the data of Taiwan National Healthcare Insurance Claims and the Death Registry between 2012 and 2017. Drug survival and treatment patterns were determined by investigating the occurrence of switching and discontinuation from index treatment. At baseline, 70.0% of patients used tumor necrosis factor inhibitors (TNFi) bDMARD with the majority taking etanercept (27.0%) or adalimumab (26.2%). During the follow-up period, 40.0% (n = 3,464) of index users switched (n = 1,479) or discontinued (n = 1,985) the treatment with an average incidence rate of 0.18 per patient-year. Among the six index treatment groups, drug survival was the lowest for adalimumab and highest for tocilizumab. When compared with etanercept, only adalimumab had a higher cumulative probability of switching/discontinuation (adjusted HR = 1.17, 95% CI: 1.08-1.28), whereas golimumab, non-TNFi bDMARDs and tofacitinib were significantly less probable to switch or discontinue. For patients switching the index treatment, tocilizumab (31.2%) and tofacitinib (23.4%) were the main regimens being switched to. In addition, 48.2% of patients who discontinued the index treatment received further retreatment, and 63.8-77.0% of them were retreated with same agent. In conclusion, this population-based study found that TNFi were the preferred agents as the index treatments during 2012-2017. Non-TNFi and tofacitinib were more common second-line agents being switched to. Nearly half of discontinued patients received retreatment, with a majority receiving the same agent.
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Affiliation(s)
- Ko-Jen Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chia-Li Chang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | | | - Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
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Morid MA, Lau M, Del Fiol G. Predictive analytics for step-up therapy: Supervised or semi-supervised learning? J Biomed Inform 2021; 119:103842. [PMID: 34146718 DOI: 10.1016/j.jbi.2021.103842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Step-up therapy is a patient management approach that aims to balance the efficacy, costs and risks posed by different lines of medications. While the initiation of first line medications is a straightforward decision, stepping-up a patient to the next treatment line is often more challenging and difficult to predict. By identifying patients who are likely to move to the next line of therapy, prediction models could be used to help healthcare organizations with resource planning and chronic disease management. OBJECTIVE To compared supervised learning versus semi-supervised learning to predict which rheumatoid arthritis patients will move from the first line of therapy (i.e., conventional synthetic disease-modifying antirheumatic drugs) to the next line of therapy (i.e., disease-modifying antirheumatic drugs or targeted synthetic disease-modifying antirheumatic drugs) within one year. MATERIALS AND METHODS Five groups of features were extracted from an administrative claims database: demographics, medications, diagnoses, provider characteristics, and procedures. Then, a variety of supervised and semi-supervised learning methods were implemented to identify the most optimal method of each approach and assess the contribution of each feature group. Finally, error analysis was conducted to understand the behavior of misclassified patients. RESULTS XGBoost yielded the highest F-measure (42%) among the supervised approaches and one-class support vector machine achieved the highest F-measure (65%) among the semi-supervised approaches. The semi-supervised approach had significantly higher F-measure (65% vs. 42%; p < 0.01), precision (51% vs. 33%; p < 0.01), and recall (89% vs. 59%; p < 0.01) than the supervised approach. Excluding demographic, drug, diagnosis, provider, and procedure features reduced theF-measure from 65% to 61%, 57%, 54%, 51% and 49% respectively (p < 0.01). The error analysis showed that a substantial portion of false positive patients will change their line of therapy shortly after the prediction period. CONCLUSION This study showed that supervised learning approaches are not an optimal option for a difficult clinical decision regarding step-up therapy. More specifically, negative class labels in step-up therapy data are not a robust ground truth, because the costs and risks associated with higher line of therapy impact objective decision making of patients and providers. The proposed semi-supervised learning approach can be applied to other step-up therapy applications.
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Affiliation(s)
- Mohammad Amin Morid
- Department of Information Systems and Analytics, Leavey School of Business, Santa Clara University, Santa Clara, CA, United States.
| | - Michael Lau
- Advanced Analytics, Gilead Sciences, San Francisco, CA, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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de Oliveira Costa J, Bruno C, Baranwal N, Gisev N, Dobbins TA, Degenhardt L, Pearson SA. Variations in Long-term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000-2019). Br J Clin Pharmacol 2021; 87:3706-3720. [PMID: 33629352 DOI: 10.1111/bcp.14798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
Routinely collected data have been increasingly used to assess long-term opioid therapy (LTOT) patterns, with very little guidance on how to measure LTOT from these data sources. We conducted a systematic review of studies published between January 2000 and July 2019 to catalogue LTOT definitions, the rationale for definitions and LTOT rates in observational research using routinely collected data in nonsurgical settings. We screened 4056 abstracts, 210 full-text manuscripts and included 128 studies, mostly from the United States (81%) and published between 2015 and 2019 (69%). We identified 78 definitions of LTOT, commonly operationalised as 90 days of use within a year (23%). Studies often used multiple criteria to derive definitions (60%), mostly based on measures of duration, such as supply days/days of use (66%), episode length (21%) or prescription fills within specified time periods (12%). Definitions were based on previous publications (63%), clinical judgment (16%) or empirical data (3%); 10% of studies applied more than one definition. LTOT definition was not provided with enough details for replication in 14 studies and 38 studies did not specify the opioids evaluated. Rates of LTOT within study populations ranged from 0.2% to 57% according to study design and definition used. We observed a substantial rise in the last 5 years in studies evaluating LTOT with large variability in the definitions used and poor reporting of the rationale and implementation of definitions. This variation impacts on research reproducibility, comparability of findings and the development of strategies aiming to curb therapy that is not guideline-recommended.
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Affiliation(s)
| | - Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Navya Baranwal
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy A Dobbins
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Walton A, Paik J, Quebe A, Kannowski CL, Choong C, Anderson S, Owensby JK. Frequency of Prescription Claims for Drugs that May Interact with Janus Kinase Inhibitors Among Patients with Rheumatoid Arthritis in the US. Rheumatol Ther 2021; 8:599-607. [PMID: 33484433 PMCID: PMC7991043 DOI: 10.1007/s40744-020-00275-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction This study describes the frequency of prescription claims for drugs that may interact with Janus kinase (JAK) inhibitors among adult patients with rheumatoid arthritis (RA) in a large US claims database. Methods This observational, retrospective, cross-sectional study of the IBM® MarketScan® Research Commercial and the Medicare Supplemental Database included adults (≥ 18 years) with ≥ 2 outpatient claims 30 or more days apart or ≥ 1 inpatient visit claim with an RA diagnosis between January 1, 2013 and March 31, 2017 (the index period). During the study period, from January 1, 2013 to March 31, 2018, strong organic anion transporter (OAT3) inhibitors, strong cytochrome P450 (CYP) 3A4 inhibitors, and moderate or strong CYP3A4 inhibitors in combination with strong CYP2C19 inhibitors, were identified as drugs with potential for drug–drug interactions (DDIs) with JAK inhibitors approved for RA treatment in the US. Descriptive statistics were conducted. Results A total of 152,853 patients met eligibility criteria. Approximately 76% were women and the median age was 57 years. Of these patients, < 0.1% had a claim for a strong OAT3 inhibitor, and 1% had claims for the combination of a strong CYP3A4 and strong CYP2C19 inhibitor; 3% of patients had a claim for a strong CYP3A4 inhibitor and almost 10% had claims for both a moderate CYP3A4 and a strong CYP2C19 inhibitor. Conclusions Up to 10% of RA patients have been prescribed a drug with a potential JAK interaction. Rheumatologists should consider potential DDIs when managing patients with RA.
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Affiliation(s)
- Alison Walton
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA.
| | - Jim Paik
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | - Justin K Owensby
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Ward MM, Dasgupta A. Pre-operative withholding of infliximab and the risk of infections after major surgery in patients with rheumatoid arthritis. Rheumatology (Oxford) 2020; 59:3917-3926. [PMID: 32710102 DOI: 10.1093/rheumatology/keaa291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Withholding TNF inhibitors (TNFI) before surgery has been recommended due to concern for post-operative infection. We examined the risks of post-operative infections and mortality in patients with RA in relation to the pre-operative timing of infliximab infusion. METHODS In this population-based retrospective cohort study, we used US Medicare claims data from 2007 to 2015 to identify patients with RA who underwent coronary artery bypass grafting (CABG), aortic or vascular surgery, or bowel resection, and who were treated with infliximab in the 90 days prior to surgery. We examined associations between the timing of infusion and infections and mortality in the 30 days after surgery. We adjusted for the predicted probability of post-operative infection or death, demographic characteristics, use of MTX, post-operative blood transfusion and hospital volume. RESULTS We studied 712 patients with CABG, 244 patients with vascular surgery and 862 patients with bowel resections. Post-operative pneumonia occurred in 7.4-11.9%, urinary tract infection in 9.0-15.2%, surgical site infection in 3.2-18.9%, sepsis in 4.2-9.6% and death in 3.5-7.0% among surgery cohorts. There was no association between the time from last infliximab dose to surgery and the risk of post-operative infection or mortality in any surgical cohort. No subgroups were identified that had an increased risk of infection with more proximate use of infliximab. CONCLUSION Among elderly patients with RA, risks of infection and mortality after major surgery were not related to the pre-operative timing of infliximab infusion.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Abhijit Dasgupta
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Cruz BH, Garnica IU, Parera RS, Romero ER, Gutiérrez JC, Sánchez AG, Escalera CR, Sarabia FN. Disease-modifying antirheumatic drug prescription patterns in adult rheumatoid arthritis patients in routine clinical practice in Spain. Eur J Rheumatol 2020; 7:eurjrheum.2020.19053. [PMID: 32910753 PMCID: PMC7574759 DOI: 10.5152/eurjrheum.2020.19053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/11/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe disease-modifying antirheumatic drug (DMARD) patterns in routine clinical practice in adult rheumatoid arthritis (RA) patients and to ascertain the reasons for methotrexate (MTX) discontinuation. METHODS A cross-sectional observational study was conducted from March to October 2014 at the Rheumatology Units of seven hospitals in Spain. In a single visit, the treating rheumatologist completed an online case report form. This report contained sociodemographic and RA variables. This study was conducted in accordance with Good Clinical Practice and local and national research legislations. RESULTS A total of 301 patients (71% women) with a mean age of 56.7±14.0 years and disease duration of 3.6±1.5 years were examined. The patients had RA with moderate disease activity, at least one poor prognostic factor, and comorbidities. The mean time between RA diagnosis and prescription of the first conventional synthetic DMARD (csDMARD) was 2.4±6.0 months. A total of 295 patients (98%) started the first csDMARD on monotherapy. MTX was the most-prescribed first-line drug (n=233, 79%). The mean treatment time of the first-line csDMARD was 27.0±19.4 months. Of these patients, 98% progressed to a second-line csDMARD; 118 patients were changed to another DMARD, mainly due to inefficacy (51, 37%), adverse events (AEs, 37, 27%), or intolerance (18, 13%). The use of MTX as second-line therapy reduced from 79% to 51%. At the time of the study, 200 patients (66%) received a csDMARD as monotherapy and 45 (15%) a combination of ≥2 csDMARDs. Fifty-five (18%) patients were being treated with a biological drug in monotherapy (16, 29%) or in a combination with a csDMARD (39, 71%), mainly MTX, 147 patients (57%) received steroids. Biological DMARD were prescribed as the second line for 42% of patients and 51% of patients received the third-line therapy or beyond. The rate of AEs that motivated a change in the csDMARD was 34%. CONCLUSION MTX was the most-used csDMARD as first and second-line therapy together with corticosteroids. The combination of two or more csDMARDs as first-line treatment was very infrequent. MTX toxicity and intolerance were higher and more significant than inefficacy but progressively decreased with use.
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Affiliation(s)
| | | | | | - Esteban Rubio Romero
- Department of Rheumatology, Virgen del Rocio University Hospital, Seville, Spain
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12
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Muilu P, Rantalaiho V, Kautiainen H, Virta LJ, Puolakka K. Opioid Use among Patients with Early Inflammatory Arthritides Compared to the General Population. J Rheumatol 2020; 47:1285-1292. [PMID: 31615910 DOI: 10.3899/jrheum.190355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess to what extent the worldwide opioid epidemic affects Finnish patients with early inflammatory arthritis (IA). METHODS From the nationwide register maintained by the Social Insurance Institution of Finland, we collected all incident adult patients with newly onset seropositive and seronegative rheumatoid arthritis (RA+ and RA-) and undifferentiated arthritis (UA) between 2010 and 2014. For each case, 3 general population (GP) controls were matched according to age, sex, and place of residence. Drug purchases between 2009 and 2015 were evaluated 1 year before and after the index date (date of IA diagnosis), further dividing this time into 3-month periods. RESULTS A total of 12,115 patients (66% women) were identified. At least 1 opioid purchase was done by 23-27% of the patients 1 year before and 15-20% one year after the index date. Relative risk (RR) of opioid purchases compared to GP was highest during the last 3-month time period before the index date [RR 2.81 (95% CI 2.55-3.09), 3.06 (2.68-3.49), and 4.04 (3.51-4.65) for RA+, RA-, and UA, respectively] but decreased after the index date [RR 1.38 (1.23-1.58), 1.91 (1.63-2.24), and 2.51 (2.15-2.93)]. Up to 4% of the patients were longterm users both before and after the diagnosis. CONCLUSION During 2009-15 in Finland, opioid use peaked just before the diagnosis of IA but decreased rapidly after that, suggesting effective disease control, especially in seropositive RA. Further, opioids were used to treat arthritis pain of patients with incident RA and UA less often than previously reported from other countries.
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Affiliation(s)
- Paula Muilu
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland. .,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital.
| | - Vappu Rantalaiho
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
| | - Hannu Kautiainen
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
| | - Lauri Juhani Virta
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
| | - Kari Puolakka
- From the Department of Medicine, Tampere University Hospital; Centre for Rheumatic Diseases, Tampere University Hospital; Faculty on Medicine and Health Technology, Tampere University, Tampere; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital; Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre, Helsinki; Unit of Primary Health Care, Turku University Hospital; Research Department, Social Insurance Institution of Finland, Turku; Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,P. Muilu, MD, Medical Specialist in Internal Medicine in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; V. Rantalaiho, MD, PhD, Docent, Specialist in Rheumatology in the Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital and Faculty on Medicine and Health Technology, Tampere University; H. Kautiainen, Biostatistician, Primary Health Care Unit, Kuopio University Hospital, and Folkhälsan Research Centre; L.J. Virta, MD, PhD, Docent, Research Department, Social Insurance Institution of Finland; K. Puolakka, MD, PhD, Docent, Specialist in Rheumatology, Chief of Division, Department of Internal Medicine, Centre for Rheumatic Diseases, South Karelia Central Hospital
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Rebane K, Aalto K, Haanpää M, Puolakka K, Virta LJ, Kautiainen H, Pohjankoski H. Initiating disease-modifying anti-rheumatic drugs rapidly reduces purchases of analgesic drugs in juvenile idiopathic arthritis. Scand J Rheumatol 2020; 50:28-33. [PMID: 32686548 DOI: 10.1080/03009742.2020.1762923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To describe the use of analgesics 12 months before and after initiation of the first disease-modifying anti-rheumatic drug (DMARD) in children with juvenile idiopathic arthritis (JIA). Method: A register-based study linked three nationwide registers in Finland: the Register on Reimbursement for Prescription Medicines, the Drug Purchase Register (both maintained by the Finnish Social Insurance Institution), and the Finnish Population Register. The study ran from 1 January 2010 to 31 December 2014. It included 1481 patients aged < 16 years with diagnosed JIA and 4511 matched controls. Index day was the date when reimbursement for JIA medication was approved and treatment was initiated. The study period included 12 months pre- and post-index date, and purchases of prescription drugs were assessed for 3 month periods. Results: Non-steroidal anti-inflammatory drugs (NSAIDs) were purchased for 60% of the patients. Compared to controls, NSAID purchases for JIA patients were at their highest during the last 3 months before the index day [relative rate (RR) 21.2, 95% confidence interval (CI) 17.1-26.2], and they decreased steeply over the 10-12 months post-index (RR 4.0, 95% CI 3.1-5.0). Similar trends were seen with paracetamol and opioid purchases, but only 2% of patients purchased opioids during the 12 months pre-index and 1% during the 12 months post-index. Methotrexate was the most commonly used DMARD (91.9%), biologic DMARDs were used by 2.8% and glucocorticoids by 24.8% in the 3 months after the index day. Conclusion: Initiation of DMARDs rapidly reduces the need for analgesics in patients with JIA.
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Affiliation(s)
- K Rebane
- Paediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital , Helsinki, Finland
| | - K Aalto
- Paediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital , Helsinki, Finland
| | - M Haanpää
- Ilmarinen Mutual Pension Insurance Company , Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital , Helsinki, Finland
| | - K Puolakka
- Department of Medicine, South Karelia Central Hospital , Lappeenranta, Finland
| | - L J Virta
- Research Department, Social Insurance Institution of Finland , Turku, Finland
| | - H Kautiainen
- Department of General Practice and Unit of Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - H Pohjankoski
- Department of Pediatrics, Päijät-Häme Central Hospital , Lahti, Finland
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Muilu P, Rantalaiho V, Kautiainen H, Virta LJ, Eriksson JG, Puolakka K. First-year drug therapy of new-onset rheumatoid and undifferentiated arthritis: a nationwide register-based study. BMC Rheumatol 2020; 4:34. [PMID: 32637868 PMCID: PMC7333434 DOI: 10.1186/s41927-020-00127-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background In this retrospective cohort study, we evaluated the drug therapies used for early rheumatoid (RA) and undifferentiated (UA) arthritis patients. Methods From a nationwide register maintained by the Social Insurance Institution, information on sex, date of birth, and date of special medicine reimbursement decision for all new Finnish RA and UA patients between 2011 and 14 were collected, and their DMARD (Disease Modifying Antirheumatic Drug) purchases during the first year after the diagnosis were analyzed. Results A total of 7338 patients with early RA (67.3% female, 68.1% seropositive) and 2433 with early UA (67.8% female) were identified. DMARDs were initiated during the first month after the diagnosis to 92.0% of the patients with seropositive RA, 90.3% with seronegative RA and to 87.7% with UA (p < 0.001). Respectively, 72.1, 63.4, and 42.9% of the patients (p < 0.001) purchased methotrexate; 49.8, 35.9, and 16.0% (p < 0.001) as part of a DMARD combination during the first month. By the end of the first year after the diagnosis, self-injected biologics were purchased by 2.6, 5.3 and 3.1% (p < 0.001) of them. Only 1.4, 2.6 and 3.0% (p < 0.001) of the patients were not receiving any DMARDs. During the first year, 83.4% of the seropositive RA patients had purchased methotrexate, 50.4% sulfasalazine, 72.1% hydroxychloroquine, and 72.6% prednisolone. Conclusions Currently, combination therapy including methotrexate is a common treatment strategy for early seropositive RA in Finland. Despite an easy access to biologics, these drugs are seldom needed during the first year after diagnosis.
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Affiliation(s)
- Paula Muilu
- Department of Medicine, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland.,Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | - Vappu Rantalaiho
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland.,Faculty on Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Lauri J Virta
- Research Department, Social Insurance Institution of Finland, Turku, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, National University Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Kari Puolakka
- Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland
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Walsh JA, Cai Q, Lin I, Fitzgerald T, Pericone CD, Chakravarty SD. Real-world 2-year treatment patterns among patients with psoriatic arthritis treated with injectable biologic therapies. Curr Med Res Opin 2020; 36:1245-1252. [PMID: 32271088 DOI: 10.1080/03007995.2020.1754186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To assess long-term (2-year) biologic treatment patterns of psoriatic arthritis (PsA) patients who initiated adalimumab, certolizumab pegol, etanercept, golimumab, or ustekinumab.Methods: Adult patients with ≥1 pharmacy or medical claim for injectable PsA biologics (index date) were identified from the Optum's Clinformatics Data Mart (1 January 2013-31 December 2016). Adherence, persistence, post-discontinuation treatment patterns, and addition of adjunctive medications were evaluated by index biologic.Results: Of 996 patients included (mean [SD] age: 51.5 [12.6] years; female: 49.4%), the most common index biologics initiated were adalimumab (47.9%) and etanercept (34.5%). The mean [SD] proportion of days covered was 0.48 [0.32] for the index biologics. During the 24-month follow-up period, 19.7% of patients persisted on their index biologic; ustekinumab had the highest persistence rate (27.2%), followed by adalimumab (22.0%), golimumab (18.4%), certolizumab pegol (15.6%), and etanercept (15.4%). Of the 800 patients (80.3%) who discontinued their index biologic therapy, 35.0% restarted, 40.1% switched to another biologic, and 31.8% did neither during the follow-up period. The most common biologics patients switched to were adalimumab (31.2%) and ustekinumab (18.7%). Among patients who persisted with their index biologic for ≥90 days (n = 753), ≥1 adjunctive medication was added for 50.1% of patients. The most common adjunctive medications included corticosteroids (28.0% of patients), opioids (17.0%), nonsteroidal anti-inflammatory drugs (NSAIDs) (13.8%), and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) (7.3%).Conclusions: In this real-world study of use of biologic PsA therapies, 24-month persistence was low (19.7%), and treatment was frequently supplemented with adjunctive medications.
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Affiliation(s)
- Jessica A Walsh
- University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Qian Cai
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Iris Lin
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
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16
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What Explains Poor Health-related Quality of Life Associated With Opioid Use Among Adults With Chronic Noncancer Pain Conditions? A Blinder-Oaxaca Decomposition. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Sonawane K, Zhu Y, Chan W, Aguilar D, Deshmukh AA, Suarez-Almazor ME. Association of Serum Folate Levels With Cardiovascular Mortality Among Adults With Rheumatoid Arthritis. JAMA Netw Open 2020; 3:e200100. [PMID: 32101310 PMCID: PMC7137687 DOI: 10.1001/jamanetworkopen.2020.0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular (CV) mortality, attributed to chronic inflammation coupled with elevated circulatory homocysteine levels. Increasing the serum folate level reduces homocysteine, but the association of serum folate concentration with CV mortality in patients with RA has not been previously examined. OBJECTIVE To examine the association of serum folate concentration and CV mortality risk among patients with RA. DESIGN, SETTING, AND PARTICIPANTS A cohort study of the third National Health and Nutrition Examination Survey (1988-1994) and 2011 Linked Mortality File was performed. Adults aged 18 years or older with self-reported physician-diagnosed RA were included. Data analysis was performed between April 2019 and June 2019. EXPOSURE Serum folate level. MAIN OUTCOMES AND MEASURES All-cause and CV mortality risk estimated using Cox proportional hazards models, adjusted for the complex survey design and patient characteristics, including demographic characteristics, body mass index, C-reactive protein level, smoking, RA medication use, and comorbid conditions. RESULTS A total of 683 patients with RA (mean [SE] age, 55.9 [1.0] years; 225 [30.2%] men; 478 [87.0%] white) were classified into tertiles based on serum folate levels, as follows: tertile 1, folate levels less than 4.3 ng/mL (n = 239); tertile 2, folate levels 4.3 ng/mL to 8.2 ng/mL (n = 234); and tertile 3, folate levels greater than 8.2 ng/mL (n = 210). During a median (interquartile range) follow-up of 17.4 (10.0-19.4) years, a total of 392 all-cause deaths and 258 CV deaths occurred. Compared with tertile 1, patients in tertile 2 had lower all-cause mortality risk (hazard ratio [HR], 0.63; 95% CI, 0.47-0.85). The risk of CV mortality was lower among patients in tertile 2 (HR, 0.52; 95% CI, 0.30-0.92) and tertile 3 (HR, 0.44; 95% CI, 0.26-0.75) compared with those in tertile 1 (P for trend = .01). Findings for CV mortality were consistent in a sensitivity analysis that estimated 10-year risk; patients in tertile 2 (HR, 0.31; 95% CI, 0.17-0.57) and tertile 3 (HR, 0.39; 95% CI, 0.22-0.69) had lower CV mortality risk compared with those in tertile 1 (P for trend = .04). CONCLUSIONS AND RELEVANCE Among patients with RA, a serum folate level of at least 4.3 ng/mL was associated with lower CV mortality risk. Further research is needed to examine whether a causal relationship exists between serum folate and CV risk among patients with RA.
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Affiliation(s)
- Kalyani Sonawane
- Center for Healthcare Data, Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston
- Center for Health Services Research, Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston
| | - Yenan Zhu
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston
| | - David Aguilar
- Department of Medicine, Division of Cardiology, University of Texas Health Medical School at Houston
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston
| | - Maria E. Suarez-Almazor
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
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Walsh JA, Pei S, Penmetsa GK, Sauer BC, Patil V, Walker JH, Clewell J, Douglas KM, Clegg DO, Cannon GW, Halwani A. Treatment Patterns with Disease-Modifying Antirheumatic Drugs in U.S. Veterans with Newly Diagnosed Rheumatoid Arthritis, Psoriatic Arthritis, or Ankylosing Spondylitis. J Manag Care Spec Pharm 2019; 25:1218-1228. [PMID: 31663467 PMCID: PMC10398041 DOI: 10.18553/jmcp.2019.25.11.1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Delays in treatment for inflammatory arthritis (IA) are associated with unfavorable outcomes, including impaired quality of life, irreversible joint damage, and disability. OBJECTIVE To characterize treatment initiation patterns in veterans with newly diagnosed rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS). METHODS ICD-9/10-CM codes and natural language processing were used to identify incident cases of RA, PsA, or AS between January 1, 2007, and December 31, 2015, in patients enrolled in the Veterans Health Administration. Patterns of treatment initiation and nontreatment with disease-modifying antirheumatic drugs (DMARDs) were assessed in the 12-month follow-up period after the incident diagnosis. Outcomes included the percentage of veterans treated with a DMARD, the mean time to the initial DMARD after diagnosis, and the percentage of veterans who accessed rheumatology care before DMARD initiation. To assess outcomes over time, veterans were grouped by year of initial IA diagnosis. Additionally, outcomes were compared between nonbiologic and biologic DMARDs and among IA subtypes (RA, PsA, and AS). Groups were statistically compared with 95% confidence intervals. RESULTS The population consisted of 12,118 IA veterans (9,711 RA, 1,472 PsA, and 935 AS), with 91.3% males and a mean age of 63.7 years. The percentage of veterans treated with ≥ 1 DMARD (nonbiologic or biologic) during the 12-month follow-up period increased from 48.8% in 2007 to 66.4% in 2015. In veterans diagnosed with IA in 2015, DMARD treatment was more common for PsA patients (72.9%) and RA patients (68.6%) than for AS patients (28.9%). In the subset treated with a DMARD within 12 months after diagnosis, the mean time to the initial DMARD after diagnosis did not change throughout the observation period (35.5 days for RA, 43.9 days for PsA, and 59.5 days for AS). Rheumatology specialty care was accessed by 87.4% of veterans treated with a nonbiologic DMARD and 92.2% of veterans treated with a biologic DMARD, in patients diagnosed in 2015. CONCLUSIONS DMARD treatment rates during the initial 12 months after diagnosis increased between 2007 and 2015, but nontreatment remained common, particularly in veterans with AS. The time to treatment after diagnosis was stable over time; it was shortest for RA, intermediate for PsA, and longest for AS. DMARD treatment was uncommon in veterans who did not access rheumatology specialty care. DISCLOSURES AbbVie Pharmaceuticals and Marriott Daughters Foundation funded this study via investigator-initiated grants. Data analyses were completed by investigators independent of AbbVie and Marriott Daughters Foundation. Walker, Clewell, and Douglas are employed by, and stockholders in, Abbvie. Halwani reports grants from BMS, Kyowa Hakko Kirin, Seattle Genetics, Roche-Genentech, Miragen, Immunedesign, Takeda, Amgen, Pharmacyclics, and Abbvie. The other authors have nothing to disclose.
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Affiliation(s)
- Jessica A. Walsh
- Division of Rheumatology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | - Shaobo Pei
- Division of Epidemiology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | - Gopi K. Penmetsa
- Division of Rheumatology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | - Brian C. Sauer
- Division of Epidemiology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | - Vikas Patil
- Division of Epidemiology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | | | | | | | - Daniel O. Clegg
- Division of Rheumatology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | - Grant W. Cannon
- Division of Rheumatology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
| | - Ahmad Halwani
- Division of Hematology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers
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Batko B, Batko K, Krzanowski M, Żuber Z. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med 2019; 8:E1416. [PMID: 31500394 PMCID: PMC6780913 DOI: 10.3390/jcm8091416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence-practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.
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Affiliation(s)
- Bogdan Batko
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, Poland.
- Department of Rheumatology, J. Dietl Specialist Hospital, Skarbowa 1 St, 31-121 Cracow, Poland.
| | - Krzysztof Batko
- Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland.
| | - Marcin Krzanowski
- Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland.
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, Poland.
- Ward for Older Children with Neurology and Rheumatology Subdivision, St. Louis Regional Specialised Children's Hospital, 31-503 Cracow, Poland.
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Boytsov NN, Bhattacharya R, Saverno K, Dixon L, Abbott PL, Zhang X, Gaich CL, Nair R. Health Care Effect of Disease-Modifying Antirheumatic Drug Use on Patients with Rheumatoid Arthritis. J Manag Care Spec Pharm 2019; 25:879-887. [PMID: 31347977 PMCID: PMC10398047 DOI: 10.18553/jmcp.2019.25.8.879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disease-modifying antirheumatic drugs (DMARDs) are recommended as the standard of care for patients with rheumatoid arthritis (RA) due to their ability to reduce pain and disability; however, DMARD use is low in some subgroups of the RA population. OBJECTIVE To identify characteristics associated with DMARD use in the overall cohort of patients with RA and newly diagnosed RA patients. METHODS This retrospective observational study used claims from a large national health plan. Use of DMARDs was measured according to the Healthcare Effectiveness Data and Information Set (HEDIS) as the proportion of patients with RA receiving DMARDs. Following HEDIS measure technical specifications, we identified patients aged 18-89 years with continuous enrollment during 2014 (measurement year) with ≥ 2 claims for RA outpatient visits and/or discharges on different dates between January and November 2014. Additionally, we identified a subset of patients newly diagnosed with RA in 2014 based on absence of any claims for RA or DMARDs in 2013. Descriptive analyses and bivariate associations were used to compare demographic and clinical characteristics of patients with RA with or without DMARD use in 2014. Health care resource utilization (HCRU) and costs were compared in 2014 for patients enrolled in Medicare Advantage Prescription Drug (MAPD) plans during both 2014 and 2015. Regression models were used to evaluate patient and provider characteristics associated with DMARD use in 2014 and the effect on HCRU and costs. RESULTS Among the 33,880 patients identified with RA in 2014, most patients received a DMARD (75.2%); 29.4% of patients newly diagnosed with RA had been treated with DMARDs in 2014. Patients with DMARD use, on average, were younger (aged 67 years ± 10.7 vs. 69 years ± 10.7) and healthier (Deyo-Charlson Comorbidity Index [DCCI] 2.4 ± 1.9 vs. 2.6 ± 2.1) and included a greater proportion of women (75.9% vs. 71.0%) than those with no DMARD use (P < 0.0001). Use of DMARDs (P < 0.0001) was associated with 14.5% fewer hospitalizations and 18.0% fewer emergency department visits. Although total costs increased by 15.0% with use of DMARDs, when the cost of DMARDs was excluded, the total cost decreased by 13.7% (P < 0.0001). Female gender (32.2%), higher claims-based index for RA severity score (47.0%), higher RxRisk-V score (26.7%), visit to a rheumatologist (34.3%), and use of glucocorticoids (17.7%) increased the odds of DMARD use (P < 0.0001). Use of certain classes of medication, such as nonsteroidal anti-inflammatory drugs (12.3%), opioids (19.5%), antidepressants (20.0%), muscle relaxants (12.5%), and anticonvulsants (15.5%), were associated with lower use of DMARDs (P < 0.0001). CONCLUSIONS We found significant differences in demographic and clinical characteristics between patients with and without DMARD use, which can potentially inform treatment decisions regarding DMARD use as deemed necessary by the provider. Future research should investigate the reasons for lack of treatment. DISCLOSURES This study was supported by funding from Eli Lilly to Humana as a collaborative research project involving employees of both companies. Boytsov, Saverno, Zhang, and Gaich are employees of Eli Lilly. Nair, Bhattacharya, Abbott, and Dixon are employees of Humana, which received funding from Eli Lilly to complete this research.
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Affiliation(s)
| | | | | | | | | | | | | | - Radhika Nair
- Humana Healthcare Research, Louisville, Kentucky
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Reiss AB, Silverman A, Khalfan M, Vernice NA, Kasselman LJ, Carsons SE, De Leon J. Accelerated Atherosclerosis in Rheumatoid Arthritis: Mechanisms and Treatment. Curr Pharm Des 2019; 25:969-986. [DOI: 10.2174/1381612825666190430113212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/14/2019] [Indexed: 12/11/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder that increases the risk of developing cardiovascular disease. There is accumulating evidence that the RA disease state accelerates the formation of atherosclerotic plaques. Treatments for RA improve joint symptomatology and may reduce inflammation, but consideration of their effects on the cardiovascular system is generally low priority.Objective:Since cardiovascular disease is the leading cause of mortality in RA patients, the impact of RA therapies on atherosclerosis is an area in need of attention and the focus of this review.Results:The drugs used to treat RA may be analgesics, conventional disease-modifying anti-rheumatic drugs, and/or biologics, including antibodies against the cytokine tumor necrosis factor-α. Pain relievers such as nonselective non-steroidal anti-inflammatory drugs and cyclooxygenase inhibitors may adversely affect lipid metabolism and cyclooxygenase inhibitors have been associated with increased adverse cardiovascular events, such as myocardial infarction and stroke. Methotrexate, the anchor disease-modifying anti-rheumatic drug in RA treatment has multiple atheroprotective advantages and is often combined with other therapies. Biologic inhibitors of tumor necrosis factor-α may be beneficial in preventing cardiovascular disease because tumor necrosis factor-α promotes the initiation and progression of atherosclerosis. However, some studies show a worsening of the lipid profile in RA with blockade of this cytokine, leading to higher total cholesterol and triglycerides.Conclusion:Greater understanding of the pharmacologic activity of RA treatments on the atherosclerotic process may lead to improved care, addressing both damages to the joints and heart.
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Affiliation(s)
- Allison B. Reiss
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Andrew Silverman
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Muhammed Khalfan
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Nicholas A. Vernice
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Lora J. Kasselman
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Steven E. Carsons
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
| | - Joshua De Leon
- Winthrop Research Institute, Department of Medicine, NYU Winthrop Hospital, 101 Mineola Boulevard, Suite 4-004, Mineola, NY 11501, United States
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Opioid use in rheumatoid arthritis: trends, efficacy, safety, and best practices. Curr Opin Rheumatol 2019; 31:264-270. [DOI: 10.1097/bor.0000000000000602] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Khilfeh I, Guyette E, Watkins J, Danielson D, Gross D, Yeung K. Adherence, Persistence, and Expenditures for High-Cost Anti-Inflammatory Drugs in Rheumatoid Arthritis: An Exploratory Study. J Manag Care Spec Pharm 2019; 25:461-467. [PMID: 30917076 PMCID: PMC10398092 DOI: 10.18553/jmcp.2019.25.4.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Drugs for inflammatory conditions are one of the highest expenditure therapeutic classes for health plans. Published literature for adherence, persistence, nonadherence risk factors, and health care costs are incomplete for newer biologic agents. OBJECTIVES To (a) examine differences in adherence, persistence, switch patterns, and health care costs among high-cost specialty anti-inflammatory medications and (b) suggest risk factors for nonadherence in rheumatoid arthritis. METHODS In this exploratory retrospective cohort study, we used medical and pharmacy claims from 1.2 million enrollees in commercial health plans administrated by Premera Blue Cross, the largest not-for-profit health plan in the Pacific Northwest. We included members with rheumatoid arthritis who used the following high-cost disease-modifying antirheumatic drugs: abatacept, adalimumab, anakinra, apremilast, certolizumab, etanercept, golimumab, infliximab, rituximab, sekukinumab, tocilizumab, tofacitinib, and ustekinumab. Adherence was calculated via medication possession ratio. Persistence was calculated as the amount of days between the initial fill and final fill plus days supply. Switch rates for adalimumab and etanercept were calculated as the percentage of members who switched to another target drug during the observation period. Direct medical costs (total health care costs) and health care costs excluding specialty agents were calculated using the net allowable amount per claim for the duration of each therapy. Adherence, persistence, and costs of care were also examined for concurrent methotrexate use for the most used target drugs. RESULTS The most commonly used drugs were abatacept (n = 47), adalimumab (n = 226), and etanercept (n = 252). Nonadherence in certain subgroups was associated with higher mean monthly health care costs, excluding specialty agents (etanercept cohort: +$1,063 for nonmethotrexate users; +$492 for nonadherent methotrexate users), but adherence was associated with higher total health care costs (+$883 for etanercept). Relative to specialty pharmacies, retail was associated with 9% higher nonadherence. Concurrent methotrexate use was associated with higher persistence (+307 and +192 days with adalimumab and etanercept). The most commonly switched-to drug after adalimumab/etanercept was abatacept (n = 39). CONCLUSIONS This exploratory study raises signals suggesting that retail pharmacies may be associated with higher nonadherence; nonadherence may be associated with increased health care costs, excluding specialty agents; adherence may increase total health care costs; and methotrexate use may be associated with increased persistence. Future research should confirm these findings. DISCLOSURES This research was part of an internship awarded to Khilfeh by the AMCP Foundation/Pfizer Summer Internship Program and funded by Pfizer. Gross is an employee of Pfizer. The other authors have nothing to disclose. A portion of this research was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting as a continuing education session entitled "The Evolving Role of Real-World Data in Health Care Decision Making" on March 29, 2017, in Denver, CO, and at AMCP Nexus 2016 as a poster on October 3-6, 2016, in National Harbor, MD.
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Affiliation(s)
| | - Eric Guyette
- Premera Blue Cross, Mountlake Terrace, Washington
| | - John Watkins
- University of Washington School of Pharmacy, Seattle, and Premera Blue Cross, Mountlake Terrace, Washington
| | | | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle
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Gomides APM, de Albuquerque CP, Santos ABV, Amorim RBC, Bértolo MB, Júnior PL, Santos IA, Giorgi RDN, Sacilotto NDC, Radominski SC, Borghi FM, Guimarães MFBR, Pinto MRDC, Resende GG, Bonfiglioli KR, da Silva HC, Sauma MDFLDC, Sauma ML, de Medeiros JB, Pereira IA, de Castro GRW, Brenol CV, Xavier RM, da Mota LMH, Pinheiro GDRC. Causes of synthetic disease-modifying drug discontinuation in rheumatoid arthritis: Data from a large real-life cohort. PLoS One 2019; 14:e0213219. [PMID: 30822348 PMCID: PMC6396919 DOI: 10.1371/journal.pone.0213219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/15/2019] [Indexed: 02/07/2023] Open
Abstract
The treatment of rheumatoid arthritis (RA) has evolved rapidly in recent years. Nonetheless, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard for RA treatment. The treatment for RA is expensive and this has a negative impact on public health. Given the low cost of csDMARDs compared to those of other treatment strategies, it is important to manage this type of treatment properly. Information on the duration of use of each drug and the reasons for their discontinuation is relevant to medical practitioners as it could improve the information available regarding side effects and their proper management. Moreover, data from clinical practice in the population can provide health care managers with information for resource allocation and optimization of csDMARD use with a consequent cost reduction in the treatment of RA. In this cross-sectional study, we aimed to describe the use of csDMARDs in public health services in Brazil, emphasizing on the duration of use and reasons for discontinuation of each drug. This study is a part of the REAL, a multicenter project that evaluated Brazilian patients with RA from eleven rheumatology services from August to October 2015. Patients were examined clinically, and an analysis of complementary exams and medical records was performed. A total of 1125 patients were included. 98.5% were women with a median age of 55.6 years. 36% and 90.84% patients were using biological disease-modifying drugs (bDMARDs) and csDMARDs, respectively. The duration of use and doses of each medication and the causes of suspension were analyzed. Most of the patients analyzed in this study were using csDMARDs for prolonged periods and methotrexate showed the longest duration of use. Interruption indexes due to ineffectiveness and side effects were analyzed. The knowledge of common adverse effects may alert attending physicians to the proper management of effective and low-cost therapeutic groups.
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Affiliation(s)
- Ana Paula Monteiro Gomides
- Departamento de Reumatologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil
- Departamento do curso de Medicina, Centro Universitário de Brasília- Uniceub, Brasília, Distrito Federal, Brazil
- * E-mail:
| | | | - Ana Beatriz Vargas Santos
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Manoel Barros Bértolo
- Departamento de Reumatologia, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Paulo Louzada Júnior
- Departamento de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabela Araújo Santos
- Departamento de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rina Dalva Neubarth Giorgi
- Departamento de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | - Nathalia de Carvalho Sacilotto
- Departamento de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Fernanda Maria Borghi
- Departamento de Reumatologia, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | | | - Gustavo Gomes Resende
- Departamento de Reumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Marcel Lobato Sauma
- Departamento de Reumatologia, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | - Ivânio Alves Pereira
- Departamento de Reumatologia, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Claiton Viegas Brenol
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Machado Xavier
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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