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Sheahan A, Anjohrin S, Suruki R, Stark JL, Sloan VS. Opioid use surrounding diagnosis and follow-up in patients with ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis: Results from US claims databases. Clin Rheumatol 2024; 43:1897-1907. [PMID: 38658403 PMCID: PMC11111565 DOI: 10.1007/s10067-024-06945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/20/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To describe patients' use of opioids in the year preceding and year following new diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA), compared with patients without the/se diseases. METHODS This study used US IBM® MarketScan® Commercial Claims and Encounters (CCAE) and Medicaid data and included three cohorts, comprised of incident cases of AS, PsA, or RA (2010-2017). Three matched comparator patients (without the incident disease) were selected for each patient within the disease cohort. Opioid use and appropriate treatment exposure (as defined by US guideline recommendations) in the 12-month baseline and follow-up periods were evaluated using descriptive analyses. RESULTS Prevalence of claims for opioids was higher for disease cohorts vs. comparators in CCAE; 36.4% of patients with AS, 29.5% with PsA, and 44.4% with RA did not have any claim for guideline-appropriate therapy in follow-up. Prevalence of claims for opioids was also higher for disease cohorts vs. comparators in Medicaid; 30.6% of patients with AS, 36.6% with PsA, and 65.4% with RA did not have any claim for guideline-appropriate therapy in follow-up. CONCLUSIONS In patients with AS, PsA, or RA, there was high reliance on opioids at and around the time of diagnosis. Significant proportions of patients were not on appropriate treatment as defined by professional society post-diagnosis guidelines; this discordance between actual patient therapies and treatment recommendations may suggest a need for better awareness of appropriate pain management and treatment strategies in rheumatic diseases. Key Points • This study analysed opioid use among patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA), and adds to current knowledge by expanding beyond assessment of opioid use at diagnosis, to the year before and after diagnosis. • Opioid use was found to be highly prevalent in AS, PsA, and RA in the year prior to diagnosis and, interestingly, was still seen during the year after diagnosis. • Opioids are neither disease modifying, nor a targeted/recommended treatment for chronic autoimmune diseases. In addition to their association with significant economic costs, opioids are potentially hazardous and are not better than alternative treatments with superior safety profiles. • The reasons behind opioid prescribing patterns should be explored further to support movement to targeted therapies.
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Gourzoulidis G, Solakidi A, Psarra M, Nikitopoulou E, Tzanetakos C. Cost Effectiveness of Tofacitinib for the Treatment of Active Ankylosing Spondylitis in Greece. Clin Drug Investig 2024; 44:59-69. [PMID: 38104048 DOI: 10.1007/s40261-023-01333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Ankylosing spondylitis is a chronic, progressive, inflammatory, multidimensional, musculoskeletal disease primarily involving the axial skeleton. In addition, ankylosing spondylitis is associated with increased morbidity and mortality, significantly affecting productivity and overall quality of life. The aim of the present study was to evaluate the cost effectiveness of tofacitinib compared to currently marketed biologic treatment in patients with active ankylosing spondylitis who have responded inadequately to conventional therapy (biologic-naïve population) or previous biologic therapy (biologic-experienced population) in Greece. METHODS A published model comprising a decision tree and a three-state Markov model was adapted from a public payer perspective over a lifetime horizon. Adalimumab and secukinumab, having the highest market shares among biologics for the treatment of ankylosing spondylitis in Greece (standard practice), were selected as comparators in the analysis. Clinical parameters captured treatment response defined per Assessment of Spondyloarthritis International Society 20 response, short-term and long-term changes in Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores, long-term biologic treatment discontinuation, and adverse events. Efficacy, safety data, and utility values were elicited from the published literature. Direct costs pertaining to drug acquisition, monitoring, adverse events, and disease management costs were considered in the analysis (€2022). Model outcomes were patients' quality-adjusted life-years, total costs, and incremental cost-effectiveness ratios. All future outcomes were discounted at 3.5% per annum. A probabilistic sensitivity analysis was conducted to account for model uncertainty. RESULTS In a biologic-naïve population, compared with adalimumab, tofacitinib produced an estimated 0.06 additional quality-adjusted life-years [QALYs] (10.67 vs 10.73), at additional costs of €2403 (€147,096 vs €149,500) resulting in an incremental cost-effectiveness ratio of €41,378 per QALY gained. In a biologic-experienced population, the total cost per patient for tofacitinib and secukinumab was estimated to be €151,371 and €145,757, respectively. In terms of health outcomes, tofacitinib was associated with a 0.13 increment in QALYs compared with secukinumab resulting in an incremental cost-effectiveness ratio of €42,784 per QALY gained. The probabilistic sensitivity analysis confirmed the deterministic results for both populations. CONCLUSIONS Tofacitinib was estimated to be a cost-effective option for the treatment of active ankylosing spondylitis in Greece for both biologic-naive and biologic-experienced patients.
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Affiliation(s)
| | | | - Marina Psarra
- Health Through Evidence, Agiou Panteleimonos 25, 17456, Athens, Greece
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Navarro-Compán V, Baraliakos X, Magrey M, Östör A, Saffore CD, Mittal M, Song IH, Ganz F, Stigler J, Deodhar A. Effect of Upadacitinib on Disease Activity, Pain, Fatigue, Function, Health-Related Quality of Life and Work Productivity for Biologic Refractory Ankylosing Spondylitis. Rheumatol Ther 2023; 10:679-691. [PMID: 36820984 PMCID: PMC9948782 DOI: 10.1007/s40744-023-00536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Patients with ankylosing spondylitis (AS) have significant unmet treatment needs, despite advancements in biologic therapies. This study evaluated the impact of upadacitinib on clinically meaningful improvement in patient-reported outcomes (PROs) assessing disease activity, pain, fatigue, function, health-related quality of life (HRQoL), and work productivity in patients with AS with inadequate responses or intolerance to biologic disease-modifying antirheumatic drugs (bDMARD-IR). METHODS Patients enrolled in the phase 3 SELECT-AXIS 2 AS bDMARD-IR study received blinded once-daily oral upadacitinib 15 mg or placebo for 14 weeks. The percentage of patients achieving improvements ≥ minimum clinically important differences (MCID) at week 14 were compared between treatment groups for disease activity (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI), patient global assessment of disease activity (PtGA), total and nocturnal back pain, fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue, FACIT-F), physical function (Bath Ankylosing Spondylitis Functional Index, BASFI), HRQoL (Assessment of SpondyloArthritis international Society Health Index [ASAS HI], Ankylosing Spondylitis Quality of Life [ASQoL], Short form-36 [SF-36] physical [PCS] and mental [MCS] component summary scores), and work productivity (Work Productivity and Activity Impairment [WPAI] Questionnaire). Mean changes from baseline through week 14 in fatigue and HRQoL were compared between treatment groups. RESULTS A total of 420 patients with active AS who were bDMARD-IR were included. A higher proportion of patients reported MCIDs at week 14 across all PROs with upadacitinib compared with placebo (nominal p ≤ 0.05). Greater improvements in mean change from baseline through week 14 were reported with upadacitinib compared with placebo across FACIT-F, HRQoL, and WPAI, with improvements differentiated as early as week 1 for ASAS HI, ASQoL and SF-36 PCS and week 4 for SF-36 MCS. CONCLUSIONS Upadacitinib 15 mg demonstrated rapid and clinically meaningful improvements in disease activity, pain, FACIT-F, function, HRQoL, and WPAI among bDMARD-IR patients with active AS. TRIAL REGISTRY Clinical Registration number: NCT04169373, SELECT-AXIS 2.
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Affiliation(s)
- Victoria Navarro-Compán
- Department of Rheumatology, La Paz University Hospital, IdiPaz, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | | | - Marina Magrey
- Division of Rheumatology, Case Western Reserve University School of Medicine, University Hospital of Cleveland, Cleveland, OH, USA
| | - Andrew Östör
- Cabrini Medical Center, Monash University, Melbourne, Australia
- ANU, Canberra, Australia
| | | | | | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Nissen M, Delcoigne B, Di Giuseppe D, Jacobsson L, Hetland ML, Ciurea A, Nekvindova L, Iannone F, Akkoc N, Sokka-Isler T, Fagerli KM, Santos MJ, Codreanu C, Pombo-Suarez M, Rotar Z, Gudbjornsson B, van der Horst-Bruinsma I, Loft AG, Möller B, Mann H, Conti F, Yildirim Cetin G, Relas H, Michelsen B, Avila Ribeiro P, Ionescu R, Sanchez-Piedra C, Tomsic M, Geirsson ÁJ, Askling J, Glintborg B, Lindström U. The impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondyloarthritis. Rheumatology (Oxford) 2022; 61:4741-4751. [PMID: 35323903 DOI: 10.1093/rheumatology/keac174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. METHODS Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP < 1.3 and/or BASDAI < 2) and stratified by treatment. Inter-registry heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Peripheral arthritis was defined as ≥1 swollen joint at baseline (=TNFi start). RESULTS Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P < 0.001). Remission was obtained in 20% on monotherapy and 22% on co-therapy (P < 0.001); adjusted OR of 1.16 (1.07, 1.25). Remission rates at 12 months were similar in patients with/without peripheral arthritis. CONCLUSION This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy.
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Affiliation(s)
- Michael Nissen
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lucie Nekvindova
- Faculty of Medicine, Charles University, Prague.,Institute of Biostatistics and Analyses, Ltd, Brno, Czech Republic
| | | | - Nurullah Akkoc
- Division of Rheumatology, Department of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tuulikki Sokka-Isler
- University of Eastern Finland, Faculty of Health Sciences and Jyvaskyla Central Hospital, Jyvaskyla, Finland
| | | | - Maria Jose Santos
- Department of Rheumatology, Hospital Garcia de Orta, Almada.,Department of Rheumatology, University of Lisbon, Lisbon, Portugal
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Manuel Pombo-Suarez
- Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Burkhard Möller
- Department for Rheumatology and Immunology, Inselspital-University Hospital Bern, Bern, Switzerland
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gozde Yildirim Cetin
- Division of Rheumatology, Department of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Heikki Relas
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Brigitte Michelsen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo.,Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Pedro Avila Ribeiro
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ruxandra Ionescu
- Sfanta Maria Hospital, University of Medicine and Pharmacy, Bucharest, Romania
| | - Carlos Sanchez-Piedra
- Health Technology Assessment Agency of Carlos III Institute of Health (AETS), Madrid, Spain
| | - Matija Tomsic
- Department of Rheumatology, University Medical Centre Ljubljana.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Árni Jón Geirsson
- Department for Rheumatology, University Hospital, Reykjavik, Iceland
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet.,Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Peng F, Chen F, Wen H, Bai J, Tian Y. Measurement of pre-treatment inflammatory cytokine levels is valuable for prediction of treatment efficacy to tumor necrosis factor inhibitor in axial spondyloarthritis patients. Int J Rheum Dis 2022; 25:844-850. [PMID: 35694730 PMCID: PMC9542033 DOI: 10.1111/1756-185x.14353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/18/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
Aim To evaluate the correlation of inflammatory cytokines with the treatment response to tumor necrosis factor inhibitor (TNFi) in axial spondyloarthritis (axSpA) patients. Methods This study enrolled 86 axSpA patients and 20 healthy controls (HCs). Inflammatory cytokines including tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐1β, IL‐6, IL‐12, IL‐17A, IL‐21, IL‐23, and IL‐32 were determined in serum samples of axSpA patients before treatment and in HCs after enrollment. All patients received 40 mg adalimumab every 2 weeks for 12 weeks; meanwhile, ASAS40 (40 criteria of the Assessment by the SpondyloArthritis International Society) response rates were evaluated at weeks 2, 4, 8, and 12. Results Most inflammatory cytokines were elevated in axSpA patients compared with HCs (all P < 0.05) except for IL‐32 (P = 0.101). In axSpA patients, ASAS40 response rates were 0%, 19.5%, 34.5%, 47.1%, and 56.3% at weeks 0, 2, 4, 8, and 12, respectively. Baseline [interquartile range] IL‐6 (47.3 [32.5‐53.4] pg/mL vs 31.7 [23.0‐50.9] pg/mL, P = 0.005) and IL‐17A (127.9 [90.7‐149.5] pg/mL vs 96.6 [56.1‐112.6] pg/mL, P < 0.001) were higher in axSpA patients with ASAS40 response compared with those without ASAS40 response, while baseline TNF‐α, IL‐1β, IL‐12, IL‐21, IL‐23, and IL‐32 were not different between them (all P > 0.050). Multivariate logistic regression analysis disclosed that baseline IL‐17A (P = 0.037), C‐reactive protein (P = 0.012), and history of TNF inhibitor (P = 0.029) were independently associated with ASAS40 response. Furthermore, baseline IL‐17A, C‐reactive protein, history of TNFi, and their combination had an acceptable to good ability for predicting ASAS40 response. Conclusion Measurement of pre‐treatment inflammatory cytokine levels is valuable for predicting treatment efficacy of TNFi in axSpA patients.
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Affiliation(s)
- Fei Peng
- Department of Traditional Chinese Medicine, Section of Western Medicine Foundation Teaching and Research, Baoji Vocational & Technical College, Baoji, China
| | - Fengyun Chen
- Department of Hematology and Rheumatology, Baoji Central Hospital, Baoji, China
| | - Huijun Wen
- Department Neurology, Baoji Central Hospital, Baoji, China
| | - Jie Bai
- Department of Rheumatology and Immunology, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Yuping Tian
- Department of Hematology and Rheumatology, Baoji Central Hospital, Baoji, China
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Hunter T, Grabner M, Birt J, Isenberg K, Shan M, Teng CC, Wu J, Griffing K, Lisse J, Curtis JR. Identifying inadequate response among patients with ankylosing spondylitis and psoriatic arthritis prescribed advanced therapy in a real-world, commercially insured adult population in the USA. Clin Rheumatol 2022; 41:2863-2874. [PMID: 35672618 DOI: 10.1007/s10067-022-06230-y] [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: 01/06/2022] [Revised: 04/25/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to assess treatment patterns and frequency of inadequate response associated with advanced therapy initiation among patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in the USA. METHODS Adult patients with AS or PsA who initiated advanced therapy were identified from the HealthCore Integrated Research Database®. Inadequate response to advanced therapies (tumour necrosis factor inhibitors [TNFi] and non-TNFi biologics) was identified using a claims-based algorithm. Factors influencing inadequate response were assessed using multivariable logistic regression. RESULTS In total, 646 patients with AS, and 1433 patients with PsA were evaluated. Among patients with AS (mean age, 43 years; male, 58%), 93% patients initiated TNFi, and 69% of patients had inadequate response. In patients with PsA (mean age, 49 years; male, 47%), 67% initiated TNFi, and 77% had inadequate response. Low adherence was the main predictor of inadequate response in patients with AS (56%) and PsA (63%). Inadequate responders were more likely to be female (odds ratio [OR] 2.05 for AS and 1.37 for PsA). Prior exposure to TNFi was associated with 3.89- and 2.14-fold greater odds of inadequate response in both AS and PsA patients, respectively, while patients using methotrexate were less likely to have inadequate response (OR 0.48 for AS and 0.72 for PsA; all p < 0.05). CONCLUSIONS Over 69% of patients with AS and 77% of patients with PsA had inadequate response to their index advanced therapy during 1 year after initiation. Health plan claims data appear useful to classify inadequate responders in AS and PsA. Key Points • Estimating inadequate response to advanced therapies and identifying factors associated with this outcome using claims data could improve treatment outcomes in AS and PsA. • In a sample of commercially insured US patients, over 69% of patients with AS and 77% of patients with PsA had inadequate response to their index advanced therapy during 1 year after initiation. Patient characteristics such as sex and prior therapy use were predictive of inadequate response to advanced therapies. • Health plan claims data appear useful to classify inadequate responders in AS and PsA and identify factors associated with this outcome.
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Affiliation(s)
| | | | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | - Jianmin Wu
- Eli Lilly and Company, Indianapolis, IN, USA
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Perrone V, Losi S, Filippi E, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Analysis of the prevalence of ankylosing spondylitis and treatment patterns and drug utilization among affected patients: an Italian real-world study. Expert Rev Pharmacoecon Outcomes Res 2022; 22:327-333. [DOI: 10.1080/14737167.2022.2032663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Valentina Perrone
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | | | | | - Elisa Giacomini
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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Tumor necrosis factor inhibitor (TNFi) persistence and reasons for discontinuation in a predominantly male cohort with axial spondyloarthritis. Rheumatol Int 2021; 42:1925-1937. [PMID: 34724089 DOI: 10.1007/s00296-021-05024-w] [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: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Although tumor necrosis factor inhibitors (TNFi) have favorably altered the treatment landscape for patients with axial spondyloarthritis (axSpA), there is limited data regarding TNFi persistence and reasons for discontinuation. This is an observational time-to-event study utilizing data collected for a prospective multiple-disease registry of US Veterans with axSpA treated with TNFi therapies and recruited over a 10 year period. Clinical, serological, and comorbid parameters were collected. Corporate Data Warehouse Pharmacy files provided courses of the 5 TNFi agents, and response to treatment was documented. Individual TNFi persistence was established utilizing univariate and multivariate Cox proportional models, and reasons for discontinuation were obtained by physician chart review. Two-hundred and fifty-five axSpA patients received 731 TNFi courses. A majority of patients (84.3%) had TNFi persistence at 12 months; 63.5% and 47.1% at 24 and 36 months, respectively. Compared to adalimumab, infliximab demonstrated greater persistence, certolizumab the least. Age, smoking status, BMI, comorbidity burden, inflammatory markers and HLA-B27 did not predict TNFi persistence or discontinuation. Stroke and peripheral arterial disease increased the probability of TNFi discontinuation. Secondary non-response (SNR) was the most common reason for discontinuation (46% of all courses); non-adherence (6%) and clinical remission (2%) were uncommon. Pain score at enrollment, myocardial infarction, African American race and inflammatory bowel disease (IBD) predicted TNFi response. While initial persistence of TNFi treatment was high, a large proportion of the patients discontinued initial TNFi therapy by 3 years, primarily due to loss of efficacy. While further research identifying potential predictors of TNFi discontinuation in axSpA is warranted, access to alternate disease-modifying therapies is needed.
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Griffiths H, Smith T, Mack C, Leadbetter J, Butcher B, Acar M, Ciciriello S. Persistence to Biologic Therapy among Patients with Spondyloarthritis: An Observational Study using the OPAL Dataset. J Rheumatol 2021; 49:150-156. [PMID: 34334362 DOI: 10.3899/jrheum.201551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the treatment response and persistence to biologic DMARD (bDMARD) therapy in patients with ankylosing spondylitis (AS) in a real-world Australian cohort. METHODS This was a retrospective, non-interventional cohort study that extracted data for patients with AS from the Optimising Patient outcomes in Australian rheumatology (OPAL) dataset for the period Aug-2006 to Sep-2019. Patients were classified as either bDMARD initiators if they commenced a bDMARD during the sampling window, or bDMARD naïve if they did not. Results were summarised descriptively. Treatment persistence was calculated using Kaplan-Meier methods. Differences in treatment persistence were explored using log-rank tests. RESULTS 5048 patients with AS were identified. 2597 patients initiated bDMARDs and 2451 remained bDMARD naïve throughout the study window. Treatment with first, second and third line bDMARDs significantly reduced disease activity. Median persistence on first line bDMARDs was 96 months (95% CI 85 to 109), declining to 19 months (95% CI 16 to 22) in second line, and 14 months (95% CI 11 to 18) in third line therapy. Median persistence was longest for the golimumab treated group in all lines of therapy and shortest for the etanercept group. Differences in persistence rates according to the time-period that bDMARDs were prescribed (pre-and post-2012) were also seen for etanercept and adalimumab. CONCLUSION In this cohort all bDMARDs effectively reduced disease activity. Patients remained on their first bDMARD longer than subsequent agents. Median persistence was longest for the golimumab treated group in all lines of therapy and shortest for the etanercept group.
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Affiliation(s)
- Hedley Griffiths
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Tegan Smith
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Christopher Mack
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Jo Leadbetter
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Belinda Butcher
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Mustafa Acar
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Sabina Ciciriello
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
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Meijboom RW, Gardarsdottir H, Becker ML, de Groot MCH, Movig KLL, Kuijvenhoven J, Egberts TCG, Leufkens HGM, Giezen TJ. Switching TNFα inhibitors: Patterns and determinants. Pharmacol Res Perspect 2021; 9:e00843. [PMID: 34302442 PMCID: PMC8305431 DOI: 10.1002/prp2.843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to assess switching patterns and determinants for switching in patients initiating TNFα inhibitor (TNFα-i) treatment. Patients were included who started TNFα-i treatment between July 1, 2012 and December 31, 2017, from three Dutch hospitals, and were diagnosed with rheumatic diseases (RD), inflammatory bowel disease (IBD), or psoriasis. Outcomes were switching, defined as initiating another biological; switching patterns including multiple switches until the end of follow-up; determinants for first switch, assessed using multivariate logistic regression. A total of 2228 patients were included (median age 43.3 years, 57% female), of which 52% (n = 1155) received TNFα-i for RD, 43% (n = 967) for IBD, and 5% (n = 106) for psoriasis. About 16.6% of RD patients, 14.5% of IBD patients, and 16.0% of psoriasis patients switched at least once, mainly to another TNFα-i. TNFα-i dose escalation (OR 13.78, 95% CI 1.40-135.0) and high-dose corticosteroids initiation (OR 3.62, 95% CI 1.10-12.15) were determinants for switching in RD patients. TNFα-i dose escalation (OR 8.22, 95% CI 3.76-17.93), immunomodulator initiation/dose escalation (OR 2.13, 95% CI 1.04-4.34), high-dose corticosteroids initiation (OR 6.91, 95% CI 2.81-17.01) and serum concentration measurement (OR 5.44, 95% CI 2.74-10.79) were determinants for switching in IBD patients. Switching biological treatment occurred in about one in six patients. RD patients with TNFα-i dose escalation and/or high-dose corticosteroids initiation were more likely to switch. IBD patients with TNFα-i or immunomodulator initiation/dose escalation, high-dose corticosteroids initiation or serum concentration measurement were more likely to switch. These findings might help clinicians anticipating switching in TNFα-i treatment.
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Affiliation(s)
- Rosanne W. Meijboom
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
- Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Department of Pharmaceutical SciencesUniversity of IcelandReykjavikIceland
| | - Matthijs L. Becker
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Department of Clinical PharmacySpaarne Gasthuis, Haarlem and HoofddorpHaarlemThe Netherlands
| | - Mark C. H. de Groot
- Central Diagnostic LaboratoryDivision Laboratories, Pharmacy and Biomedical GeneticsUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Kris L. L. Movig
- Department of Clinical PharmacyMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Johan Kuijvenhoven
- Department of Gastroenterology and HepatologySpaarne Gasthuis, Haarlem and HoofddorpThe Netherlands
| | - Toine C. G. Egberts
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
- Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht Institute for Pharmaceutical SciencesUtrechtThe Netherlands
| | - Thijs J. Giezen
- Pharmacy Foundation of Haarlem HospitalsHaarlemThe Netherlands
- Department of Clinical PharmacySpaarne Gasthuis, Haarlem and HoofddorpHaarlemThe Netherlands
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11
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Sánchez-Piedra C, Sueiro-Delgado D, García-González J, Ros-Vilamajo I, Prior-Español A, Moreno-Ramos MJ, Garcia-Magallon B, Calvo-Gutiérrez J, Perez-Vera Y, Martín-Domenech R, Ruiz-Montesino D, Vela-Casasempere P, Expósito L, Sánchez-Alonso F, González-Davila E, Díaz-González F. Changes in the use patterns of bDMARDs in patients with rheumatic diseases over the past 13 years. Sci Rep 2021; 11:15051. [PMID: 34302036 PMCID: PMC8302725 DOI: 10.1038/s41598-021-94504-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
The better understanding of the safety of biologic DMARDs (bDMARDs), as well as the emergence of new bDMARDs against different therapeutic targets and biosimilars have likely influenced the use patterns of these compounds over time. The aim of this study is to assess changes in demographic characteristics, disease activity and treatment patterns in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who started a first- or second-line biologic between 2007 and mid-2020. Patients diagnosed with RA, PsA or AS included in the BIOBADASER registry from January 2007 to July 2020 were included. According to the start date of a first- or second-line biologic therapy, patients were stratified into four time periods: 2007-2009; 2010-2013; 2014-2017; 2018-2020 and analyzed cross-sectionally in each period. Demographic and clinical variables, as well as the type of biologic used, were assessed. Generalized linear models were applied to study the evolution of the variables of interest over time periods, the diagnosis, and the interactions between them. A total of 4543 patients initiated a first biologic during the entire time frame of the study. Over the four time periods, disease evolution at the time of biologic initiation (p < 0.001), disease activity (p < 0.001), retention rate (p < 0.001) and the use of tumor necrosis factor inhibitors as a first-line treatment (p < 0.001) showed a significant tendency to decrease. Conversely, comorbidities, as assessed by the Charlson index (p < 0.001), and the percentage of patients using bDMARDs in monotherapy (p < 0.001), and corticosteroids (p < 0.001) tended to increase over time. Over the entire period of the study's analysis, 3289 patients started a second biologic. The following trends were observed: decreased DAS28 at switching (p < 0.001), lower retention rates (p = 0.004), and incremental changes to the therapeutic target between the first and second biologic (p < 0.001). From 2007 until now rheumatic patients who started a biologic were older, exhibited less clinical activity, presented more comorbidities, and switched to a different biologic more frequently and earlier.
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Affiliation(s)
| | | | | | | | - Agueda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - Yanira Perez-Vera
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Spain
| | | | | | | | - Lorena Expósito
- Servicio de Reumatología, Hospital Universitario de Canarias, Calle Ofra s/n 38320, La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Enrique González-Davila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, Tenerife, Spain
| | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, Calle Ofra s/n 38320, La Laguna, Santa Cruz de Tenerife, Spain.
- Departamento de Medicina Interna, Dermatología y Cirugía, Dermatología y Psiquiatría, Universidad de La Laguna, Tenerife, Spain.
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12
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Keeling S, Maksymowych WP. JAK inhibitors, psoriatic arthritis, and axial spondyloarthritis: a critical review of clinical trials. Expert Rev Clin Immunol 2021; 17:701-715. [PMID: 33944642 DOI: 10.1080/1744666x.2021.1925541] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) and spondyloarthritis (SpA) are inflammatory arthritides associated with progressive damage, deformity and morbidity. Janus kinase (JAK) inhibitors block JAKs, cytoplasmic protein tyrosine kinases important in signal transduction and immune processes that are currently being studied as synthetic disease modifying anti-rheumatic drugs (tsDMARDs) in psoriatic arthritis and spondyloarthritis. AREAS COVERED This review evaluates published phase 2 and 3 clinical trial data for JAK kinase inhibitors for psoriatic arthritis and spondyloarthritis. A literature search using PubMed was conducted using the following keywords: 'psoriatic arthritis', 'ankylosing spondylitis', 'axial spondyloarthritis', 'non-radiographic axial spondyloarthritis', 'tofacitinib', 'baricitinib', 'filgotinib' and 'upadacitinib'. Mechanism of action, phase 2 and 3 clinical trial data, including efficacy and safety, are discussed. EXPERT OPINION JAK inhibitors are important orally administered agents conferring different degrees of selectivity toward JAK1, JAK2, and JAK3 which may have implications on efficacy and safety in PsA and SpA. Phase 2 and 3 clinical trials in PsA for tofacitinib and upadacitinib and phase 2 for filgotinib confirmed efficacy comparable to biologic DMARDs. In SpA, phase 2 and 2/3 studies confirmed significant efficacy of tofacitinib, filgotinib and upadacitinib compared to placebo. Safety was comparable to clinical trial, long-term extension, and registry data for rheumatoid arthritis.
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Affiliation(s)
- Stephanie Keeling
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
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Yu CL, Yang CH, Chi CC. Drug Survival of Biologics in Treating Ankylosing Spondylitis: A Systematic Review and Meta-analysis of Real-World Evidence. BioDrugs 2021; 34:669-679. [PMID: 32946076 DOI: 10.1007/s40259-020-00442-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The last decade has witnessed the increasing use of biologics for the treatment of ankylosing spondylitis (AS). Drug survival is an outcome incorporating real-world effectiveness and safety. However, the drug survival of biologics in treating AS is unclear. OBJECTIVE The aim was to assess the drug survival of biologics (tumor necrosis factor inhibitors and anti-interleukin-17 monoclonal antibodies) in treating AS. METHODS We conducted a systematic review and meta-analysis and searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases up to 13th May 2020. Studies that analyzed the drug survival of biologics for AS and reported the respective annual data for each biologic for at least 1 year were included. Two authors independently screened and selected studies and assessed their risk of bias. A third author was available for arbitrating discrepancies. The Newcastle-Ottawa Scale was employed to evaluate the risk of bias of included studies. We conducted a random-effects model meta-analysis to obtain pooled drug survival from year 1 to 5. We performed subgroup analyses for biologic-naïve patients, first-line versus second- and third-line biologics, discontinuation due to loss of effectiveness and adverse effects, and high-quality studies. RESULTS We included 39 studies with 32,493 patients. The drug survival decreased from 76% at year 1 to 51% at year 5 for etanercept, from 75 to 51% for adalimumab, from 76 to 53% for infliximab, from 72 to 49% for golimumab, and from 63 to 57% for certolizumab pegol. The drug survival rate for secukinumab was 0.77 (95% confidence interval 0.64‒0.90) at year 1. Subgroup analyses on biologic-naïve patients and discontinuation due to adverse effects found no differences in the drug survival of various biologics except for a lower drug survival of infliximab in biologic-naïve patients. The drug survival for first-line biologics was higher than for second- and third-line biologics. CONCLUSION To the best of our knowledge, this study is the first systematic review and meta-analysis on the drug survival of biological therapies for AS patients. The drug survival of all biologics in treating AS appeared comparable, but is higher in first-line biologics than second- and third-line biologics. To date there are scarce data on the drug survival of newly available biologics, for example, anti-interleukin-17 biologics. PROSPERO REGISTRATION NO CRD42018114204.
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Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chung-Han Yang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan, 33305, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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14
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Huang X, Chen Z, Li M, Zhang Y, Xu S, Huang H, Wu X, Zheng X. Herbal pair Huangqin-Baishao: mechanisms underlying inflammatory bowel disease by combined system pharmacology and cell experiment approach. BMC Complement Med Ther 2020; 20:292. [PMID: 32988394 PMCID: PMC7523401 DOI: 10.1186/s12906-020-03068-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a severe digestive system condition, characterized by chronic and relapsing inflammation of the gastrointestinal tract. Scutellaria baicalensis Georgi (Huangqin, HQ) and Paeonia lactiflora Pall (Baishao, BS) from a typical herbal synergic pair in traditional Chinese medicine (TCM) for IBD treatments. However, the mechanisms of action for the synergy are still unclear. Therefore, this paper aimed to predict the anti-IBD targets and the main active ingredients of the HQ-BS herbal pair. METHODS A systems pharmacology approach was used to identify the bioactive compounds and to delineate the molecular targets and potential pathways of HQ-BS herbal pair. Then, the characteristics of the candidates were analyzed according to their oral bioavailability and drug-likeness indices. Finally, gene enrichment analysis with DAVID Bioinformatics Resources was performed to identify the potential pathways associated with the candidate targets. RESULTS The results showed that, a total of 38 active compounds were obtained from HQ-BS herbal pair, and 54 targets associated with IBD were identified. Gene Ontology and pathway enrichment analysis yielded the top 20 significant results with 54 targets. Furthermore, the integrated IBD pathway revealed that the HQ-BS herbal pair probably acted in patients with IBD through multiple mechanisms of regulation of the nitric oxide biosynthetic process and anti-inflammatory effects. In addition, cell experiments were carried out to verify that the HQ-BS herbal pair and their Q-markers could attenuate the levels of nitric oxide (NO), prostaglandin E2 (PGE2), inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in lipopolysaccharide (LPS)-stimulated THP-1-derived macrophage inflammation. In particular, the crude materials exerted a much better anti-inflammatory effect than their Q-markers, which might be due to their synergistic effect. CONCLUSION This study provides novel insight into the molecular pathways involved in the mechanisms of the HQ-BS herbal pair acting on IBD.
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Affiliation(s)
- Xiaoqi Huang
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Zhiwei Chen
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Minyao Li
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
| | - Yaomin Zhang
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Shijie Xu
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China
| | - Haiyang Huang
- Dongguan Mathematical Engineering Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan, 523808, China
| | - Xiaoli Wu
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, 100# Wai Huan West Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China.
| | - Xuebao Zheng
- Mathematical Engineering Academy of Chinese Medicine, Guangdong Provincial Key Laboratory of New Chinese Medicinal Development and Research, Guangzhou University of Chinese Medicine, 232# Wai Huan East Road, Guangzhou Higher Education Mega Center, Guangzhou, 510006, China.
- Dongguan Songshan Lake Yi Dao TCM Clinic, Dongguan, 523808, China.
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15
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Perrone V, Giacomini E, Sangiorgi D, Andretta M, Menti AM, Naclerio M, Ritrovato D, Degli Esposti L. Treatment Pattern Analysis and Health-care Resource Consumption on Patients with Psoriatic Arthritis or Ankylosing Spondylitis Treated with Biological Drugs in a Northern Italian Region. Ther Clin Risk Manag 2020; 16:509-521. [PMID: 32606710 PMCID: PMC7293402 DOI: 10.2147/tcrm.s248390] [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: 02/05/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the treatment patterns of psoriatic arthritis (PSA) or ankylosing spondylitis (AS) patients under biological therapies and to evaluate in this population the health-care resource consumption and related costs. Patients and Methods A retrospective analysis was performed on administrative databases of the Veneto region. Patients ≥18 years with at least one prescription of biological drugs and a diagnosis at any level for PSA or AS from January 1, 2011 to December 31, 2016 (inclusion period) were included. Index date (ID) was defined as date of first biological drug prescription during inclusion period. Patients were characterized the year before ID and followed-up for one year after ID. The drug utilization profile in terms of adherence, persistence and therapeutic regimen changes, and the health-care resource consumption was analyzed during follow-up. Results A total of 2602 patients were included: 1857 with PSA and 745 with AS. In the PSA cohort, 40.3% of patients were prescribed adalimumab, 35.6% etanercept, 8.0% golimumab, 7.5% infliximab, 5.6% ustekinumab and 3.0% certolizumab. Percentage of PSA patients adherent to treatment was higher among ustekinumab patients (91.3%) and lower among etanercept users (54.3%). Persistence ranged from 53.2% (infliximab) to 70.3% (etanercept). Regarding AS cohort, 45.5% of patients were prescribed adalimumab, 26% etanercept, 17.3% infliximab, 9.7% golimumab and 1.5% certolizumab. Adherence ranged from 46.9% (etanercept) to 90.9% (certolizumab) and persistence from 62.8% (adalimumab) to 81.8% (certolizumab). Mean annual health-care costs (including costs for drug treatment, diagnostic services, specialist visits and hospital admissions) ranged from €9727 (certolizumab) to €14,994 (ustekinumab) among PSA patients and from €9875 (infliximab) to €12,991 (golimumab) among AS patients. Conclusion This study in Veneto region gave a picture of biological treatment patterns among PSA and AS patients in a real-world setting. Our findings showed the high degree of variability concerning utilization of each biological drug and provided insight on the economic burden of both diseases.
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Affiliation(s)
| | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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Acurcio FDA, Guerra Junior AA, da Silva MRR, Pereira RG, Godman B, Bennie M, Nedjar H, Rahme E. Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients: a multicenter international study. Curr Med Res Opin 2020; 36:677-686. [PMID: 31990224 DOI: 10.1080/03007995.2020.1722945] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis (AS) living in Brazil and Quebec, Canada.Methods: We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation.Results: One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1 and 30.7%, Quebec: 66.9 and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9 and 18.1%, Quebec: 51.5 and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.Conclusions: Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.
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Affiliation(s)
- Francisco de Assis Acurcio
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- Department of Social and Preventive Medicine, Post-graduated Program of Public Health, School of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Augusto Afonso Guerra Junior
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Michael Ruberson Ribeiro da Silva
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Ramon Gonçalves Pereira
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Hacene Nedjar
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
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Dutcher SK, Eworuke E, Blum MD, Ball R. Using real-world data to evaluate biosimilar switching. Pharmacoepidemiol Drug Saf 2019; 29:814-816. [PMID: 31692176 DOI: 10.1002/pds.4899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Efe Eworuke
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michael D Blum
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Robert Ball
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Chen SK, Feldman CH, Brill G, Lee YC, Desai RJ, Kim SC. Use of prescription opioids among patients with rheumatic diseases compared to patients with hypertension in the USA: a retrospective cohort study. BMJ Open 2019; 9:e027495. [PMID: 31221884 PMCID: PMC6589005 DOI: 10.1136/bmjopen-2018-027495] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Long-term opioid prescribing has increased amid concerns over effectiveness and safety of its use. We examined long-term prescription opioid use among patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), compared with patients with hypertension (HTN). METHODS We used Truven MarketScan, a US commercial claims database (2003-2014) and identified RA, SLE, PsA and AS cohorts, each matched by age and sex to patients with HTN. We compared long-term opioid prescription use during 1 year of follow-up and used multivariable Poisson regression model to estimate the relative risk (RR) of receiving opioid prescriptions based on underlying disease cohort. RESULTS We identified 181 710 RA (mean age 55.3±13.1, 77% female), 45 834 SLE (47.1±13.1, 91% female), 30 307 PsA (49.7±11.5, 51% female), 7686 AS (44.6±12.0, 39% female) and parallel numbers of age-matched and sex-matched patients with HTN. The proportion of patients receiving long-term opioid prescriptions, and other measures of opioid prescriptions were higher among rheumatic disease cohorts and highest in patients with AS. AS was associated with the highest RR of receiving long-term opioid prescriptions (RR 2.73, 95% CI 2.60 to 2.87) versus HTN, while RRs were 2.21 (2.16 to 2.25) for RA, 1.94 (1.87 to 2.00) for PsA and 1.82 (1.77 to 1.88) for SLE. CONCLUSIONS Patients with rheumatic disease have higher rates of long-term opioid prescriptions, and patients with AS have the highest risk of receiving opioid prescriptions versus patients with HTN. Further studies investigating the effectiveness of disease-targeted treatments on decreasing opioid use in these four rheumatic diseases may provide strategies for reducing prescription opioids.
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Affiliation(s)
- Sarah K Chen
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Candace H Feldman
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yvonne C Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Seoyoung C Kim
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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