The economic burden of switching targeted disease-modifying anti-rheumatic drugs among rheumatoid arthritis patients

Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis

BACKGROUND

In recent years, improved access to effective antiretroviral therapy has meant that people living with human immune virus are living longer than before. The burden of non-communicable diseases particularly, hypertension parallels with the increase in age. Although hypertension screening is thought to be an effective indicator of overall health status and paves the way for early interventions in peoples living with human immune virus, the exact prevalence of hypertension in this population remained unknown. We aimed to report the prevalence of hypertension and examine the factors associated with hypertension among people living with human immune virus in East Africa.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Science Direct, Scopus, Cochrane library, and Google Scholar databases for studies published until January 1, 2023. The search period was from January 10/2023, to February 10/ 2023. Random-effect models were used to calculate the pooled prevalence of hypertension. Subgroup analyses were conducted to explore potential heterogeneity. The Funnel plot and Egger's test were used to assess publication bias.

RESULT

A total of 15 studies with 10,916 individuals were included in the present meta-analysis. The pooled prevalence of hypertension among people living with human immune virus was19.75% (95% CI, 16.07%-23.42%)),). The prevalence of hypertension was not differed between studies conducted 2014- 2019 and, studies conducted 2020-2022. The prevalence of hypertension was lowest in Ethiopia (16.13%) and highest in Tanzania (26.76%). Alcohol consumption (Adjusted Odds Ratio (AOR): 3.39, 95% CI: 2.35-4.43), diabetes (AOR: 2.64, 95% CI: 1.89-3.39), longer duration of HIV (AOR: 1.72, 95% CI: 1.15-2.3), male sex (AOR: 1.62, 95% CI: 1.43-1.8), obesity (AOR: 2.89, 95% CI: 1.94-3.84), and older age (AOR: 2.25, 95% CI: 2.0-2.5), were the factors associated with the presence of hypertension in people living with human immune virus.

CONCLUSION

Our study shows that one in five peoples living with human immune virus have hypertension causing symptoms and impairment, therefore requiring treatment. Designing effective health screening and hypertension management intervention programs helps to prevent the occurrence of hypertension and promotes peoples' overall quality of life.

Discontinuation of biologic therapy in patients with rheumatoid arthritis and ankylosing spondylitis: analysis from multicenter cohort study

Despite of the availability of several effective bDMARDs, a significant proportion of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients discontinued bDMARDs. The aims of this study were to analyze causes of bDMARDs discontinuation in RA and AS included in the Moroccan registry RBSMR. A historical prospective multicenter cohort study based on the RBSMR database at 12 months of follow-up, which included 225 RA and 170 AS. Using T student, Mann-Whitney U, chi-squared or Fischer exact tests, baseline demographic and clinical features were compared between patients discontinuing bDMARDs and patients remaining on initiated bDMARDs or switching bDMARDs. Logistic regression models were used to identify factors associated with drugs discontinuation. 61 RA discontinued bDMARDs and 47 AS interrupted anti-TNF. The most common reasons for drugs discontinuation were adverse events (7.5%) in RA patients and social security reimbursement problems (16.8%) in AS. RA patients discontinuing bDMARDs were more frequently first-line biological drugs users, more frequently female and had more comorbidities and lower DAS28 CRP than RA patients remaining on initiated bDMARDs or switching bDMARDs (p < 0.001, p = 0.01, p < 0.001 and p < 0.001 respectively). Female sex and comorbidities were the significant predictors of bDMARDs discontinuation in RA patients. Higher baseline BASDAI had a protective role on anti-TNF interruption in AS patients. Adverse events and social security reimbursement problems were the main reasons for drugs discontinuation in RA and AS patients respectively. Female sex and comorbidities in RA patients, baseline BASDAI in AS patients impacted bDMARDs discontinuation in real-life settings.

Predictors of Treatment Change Among Patients with Rheumatoid Arthritis Treated with TNF Inhibitors as First-Line Biologic Agent in the USA: A Cohort Study from Longitudinal Electronic Health Records

BACKGROUND

Previous observational studies utilizing administrative claims data have largely been unable to consider clinical factors that may be related to patterns of drug use among patients with rheumatoid arthritis (RA).

OBJECTIVE

To understand predictors of treatment changes following initiation of a tumor necrosis factor inhibitor (TNFi) using nation-wide electronic health record (EHR) data in the USA.

METHODS

The Optum Immunology Condition EHR data (01/01/2011-09/30/2019) was used to identify a population of adult patients with RA initiating a TNFi as the first line biologic disease-modifying anti-rheumatic drug (DMARD). The primary outcome was any treatment change during the 1-year post-index period defined as cycling to a different TNFi or switching to non-TNFi biologic or targeted synthetic DMARDs. Secondary outcomes were the individual components of TNFi cycling and switching, examined separately. To identify predictors of DMARD treatment changes, we used a least absolute shrinkage and selection operator (LASSO) regression model. Model c-statistics and odds ratios (ORs, 95% confidence intervals (CIs)) of predictors were reported.

RESULTS

We identified 24,871 patients with RA who initiated a TNFi. The mean age was 55.5 (± 13.7) years and 77.2% were female. Among the TNFi initiators, 22.2% experienced TNFi cycling or switching during the 1-year follow-up time. Predictors that are associated with higher likelihood of TNFi cycling or switching included female gender (OR: 1.26, 95% CI: 1.16-1.36) and glucocorticoid use (OR: 1.30, 95% CI: 1.21-1.40). In contrast, inflammatory bowel disease (OR: 0.62, 95% CI: 0.48-0.78), psoriasis (OR: 0.82, 95% CI: 0.70-0.95), recent use of methotrexate (OR: 0.89, 95% CI: 0.81-0.97), and vitamin D intake (OR: 0.92, 95% CI: 0.85-0.99) were negatively associated with TNFi cycling or switch.

CONCLUSIONS

Gender, glucocorticoid use, inflammatory bowel disease, psoriasis, and vitamin D intake were identified as significant predictors of TNFi cycling or switching for TNFi initiators in the RA population. Predicting treatment change remains challenging even with large detailed EHR data. This study aimed to identify key determinants of treatment changes among patients with rheumatoid arthritis (RA) initiating a tumor necrosis factor inhibitor (TNFi) as their first-line biologic disease-modifying antirheumatic drug (DMARD) in routine care settings using a US nation-wide longitudinal electronic health record (EHR). Among 24,871 patients with RA who initiated a TNFi, 22.2% experienced TNFi cycling or switching during the 1-year follow-up time. Female patients and those who used glucocorticoids were more likely to experience TNFi cycling or switching, whereas inflammatory bowel disease, psoriasis, recent methotrexate use, and vitamin D intake were negatively associated with the outcome. However, predicting treatment change remains challenging even with larger detailed EHR data potentially due to unmeasured factors such as prescriber's preference or patient's belief in the medication.

Health-Care and Societal Costs Associated with Non-Persistence with Subcutaneous TNF-α Inhibitors in the Treatment of Inflammatory Arthritis (IA): A Retrospective Observational Study

Objective

A few studies have suggested that patients with inflammatory arthritis (IA) who remain persistent with subcutaneous TNF-α inhibitors (SC-TNFi) incur lower health care costs than patients who discontinue treatment, whereas data on the impact of non-persistence on indirect costs are largely lacking. Furthermore, existing estimates are based on fixed follow-ups, in relation to treatment initiation, and therefore do not measure costs in direct relation to treatment discontinuation. Therefore, by capturing costs in direct relation to treatment discontinuation, this study aimed to estimate direct and indirect costs associated with non-persistence with SC-TNFis in IA.

Methods

Adult Swedish biologic-naïve IA patients initiating biologic treatment with a SC-TNFi (adalimumab, etanercept, certolizumab or golimumab) between May 6, 2010, and December 31, 2017, were identified in population-based registers with almost complete coverage. IA was defined as a diagnosis of rheumatic arthritis, ankylosing spondylitis/unspecified spondyloarthritis or psoriatic arthritis. Non-persistent patients were matched on propensity score to patients persistent with treatment by at least an additional 12 months. This enabled comparisons of direct healthcare costs and indirect costs for sick leave and disability pension, respectively, 12 months before and 12 months after treatment discontinuation.

Results

A balanced cohort of 486 matched pairs was generated. The total direct and indirect costs were significantly higher among non-persistent patients already during the 12 months before index ($20,802 [18,335–23,429] vs. $16,600 [14,331–18,696]). However, while non-persistent patients increased their total direct and indirect costs, persistent patients significantly decreased the same, further widening the difference in costs during the 12-month period after index date ($22,161 [19,754–24,556] vs. $13,465 [11,415–15,729]).

Conclusions

Among biologic-naïve Swedish IA patients treated with SC-TNFis, persistent patients incurred about 40% lower aggregated direct and indirect costs compared to non-persistent patients the year following SC-TNFi discontinuation. This highlights the impact of treatment persistence from an economic viewpoint, adding further aspects to the clinical perspective.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01970-w.

The Incidence, Prevalence, and Associated Costs of Anemia, Malignancy, Venous Thromboembolism, Major Adverse Cardiovascular Events, and Infections in Rheumatoid Arthritis Patients by Treatment History in the United States

OBJECTIVE

Comorbidities in rheumatoid arthritis (RA) can influence treatment selection, impact treatment persistency, and increase health care costs. This study assessed the magnitude of comorbidity burden via epidemiology (incidence and prevalence) and associated costs of select comorbidities in RA patients: anemia, malignancy, venous thromboembolism (VTE), major adverse cardiovascular events (MACE), and infections, stratified by history of disease-modifying antirheumatic drug (DMARD) exposure.

METHODS

From the IQVIA PharMetrics® Plus database, we selected adult patients with RA (2 or more RA diagnostic codes at least 30 days apart) at initiation of a new DMARD (DMARD-naïve), after the first conventional synthetic DMARD (csDMARD) or after the first biologic DMARD (bDMARD). We assessed pre-index prevalence (percentage) and on-treatment incidence (per 100 patient-years [P100PY]) of the aforementioned comorbidities. For patients with versus without incident conditions, we compared total all-cause health care costs as unadjusted and adjusted for baseline characteristics and health care costs.

RESULTS

Prior to initiating a new treatment, among DMARD-naïve patients (N = 28,201), csDMARD switchers (N = 7,816), or bDMARD switchers (N = 4,656), the overall prevalence ranged from 14.1% to 16.2% (anemia), from 1.3% to 5.2% (malignancy, evaluated in csDMARD and bDMARD switchers), from 1.5% to 2.1% (VTE), from 1.8% to 2.9% (MACE), and from 66.6% to 76.1% (infections). Once on index treatment, overall incidence (P100PY) among the cohorts ranged from 6.9 to 8.9 (anemia), from 2.0 to 2.3 (malignancy), from 0.7 to 0.9 (VTE), from 1.6 to 2.0 (MACE), and from 77.4 to 87.7 (infections). The incident comorbidities (except herpes zoster) were associated with increased adjusted health care costs.

CONCLUSION

Anemia, malignancy, VTE, MACE, and infections affect patients with RA at all stages of their treatment journey and are associated with increased health care costs.

Prevalence and risk factors of hypertension among Hui population in China: A systematic review and meta-analysis based on 30,565 study participants

BACKGROUND

Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background, inadequate access to health services, eating habits, religious belief, ethnic customs, and other factors differ from that of other ethnic groups, which may influence the prevalence of HTN. However, there is no current meta-analysis on the prevalence and risk factors of HTN among Hui population. Thus we conducted a systematic review aiming to estimate the pooled prevalence and risk factors of HTN among Hui population.

METHODS

PubMed, The Cochrane library, Web of science, CINAHL Complete, Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, and SinoMed were systematically searched from inception to February 28, 2020 with publication language restricted to English and Chinese. We included cross-sectional, case-control, or cohort studies that focused on prevalence and risk factors of HTN among Hui population. Two investigators independently assessed the risk of bias of the studies included in the review using tools developed by JBI. Meta-analysis was conducted using Stata 12.0 software package.

RESULTS

Twenty-three studies were identified with a total of 30,565 study participants. The overall pooled prevalence of HTN was 28% (95% confidence interval [CI]: 24%-32%, I2 = 98.8%, P < .001). Stratified by gender, the pooled prevalence of HTN in Hui was 26% (95%CI: 20%-33%, I2 = 97.6%, P < .001) for males and 30% (95%CI: 23%-37%, I2 = 98.3%, P < .001) for females. Pooled prevalence of HTN in Hui was 2% (95%CI: 2%-6%, I2 = 70.6%, P = .065), 10% (95%CI: 3%-17%, I2 = 83.7%, P < .001), 22% (95%CI: 12%-32%, I2 = 87.9%, P < .001), 37% (95%CI: 20%-53%, I2 = 94.0%, P < .001), 39% (95%CI: 24%-54%, I2 = 97.7%, P < .001) and 42% (95%CI: 29%-56%, I2 = 95.6%, P < .001) for those aged 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively. Pooled prevalence of HTN in Hui was 22% (95%CI: 14%-29%, I2 = 97.9%, P < .001) in urban areas and 23% (95%CI: 16%-30%, I2 = 95.8%, P < .001) in rural areas. Daily salt intake (odd ratio [OR] = 3.94, 95%CI: 3.03-5.13, I2 = 90.2%, P < 001), family history (OR = 3.50, 95%CI: 2.60-4.71, I2 = 95.3%, P < .001), smoking (OR = 1.84, 95%CI: 1.61-2.09, I2 = 59.6%, P < .001), drinking (OR = 1.74, 95%CI: 1.26-2.39, I2 = 95.3%, P = .001), weekly meat intake (OR = 1.92, 95%CI: 1.04-3.54, I2 = 96.5%, P = .036), body mass index (OR = 2.20, 95%CI: 1.81-2.66, I2 = 91.3%, P < .001), and areas (OR = 1.29, 95%CI: 1.10-1.51, I2 = 81.5%, P = .001) were risk factors of HTN in Hui, while physical exercise (OR = 0.76, 95%CI: 0.66-0.88, I2 = 62.7%, P < .001) was protective factor.

CONCLUSIONS

The pooled prevalence of HTN among Hui people was 28%, daily salt intake, family history, drinking, smoking, weekly meat intake, body mass index, areas, and physical exercise were all risk factors for HTN among Hui population. Early screening and treatment of HTN among Hui population should be given due attention.