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Alotaibi A, Albarrak D, Alammari Y. The Efficacy and Safety of Biologics in Treating Ankylosing Spondylitis and Their Impact on Quality of Life and Comorbidities: A Literature Review. Cureus 2024; 16:e55459. [PMID: 38571822 PMCID: PMC10988185 DOI: 10.7759/cureus.55459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the axial skeleton, causing intense pain, progressive joint destruction, and a gradual reduction in physical function. Additionally, AS can result in extra-musculoskeletal manifestations including inflammatory bowel disease (IBD), psoriasis, and acute anterior uveitis (AAU) affecting patients' quality of life (QoL). Furthermore, AS association with neurological and cardiovascular events has been documented. With the advent of biologics, treating AS has dramatically changed due to their high efficacy and tolerable safety. Nevertheless, there are differences in traits, including rapidity of onset, long-term efficacy, safety profile, and influence on comorbidities. A better understanding of such traits enables clinicians to make the best decision for each patient, increasing persistence, extending medication survival, enhancing patient satisfaction, and reducing the disease effect of AS. A review of the literature published in English in PubMed and Google Scholar databases from 2010 to 2023 was conducted. All relevant results fitting the scope of the topic were included. In this article, we emphasize biologics' efficacy and safety profile in patients with AS. In addition, we discuss the impact of biologics on comorbidities and health-related quality of life (HRQoL).
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Affiliation(s)
| | - Danah Albarrak
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yousef Alammari
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Wang Y, Li S, Bai J, Cai X, Tang S, Lin P, Sun Q, Qiao J, Fang H. Bimekizumab for the treatment of moderate-to-severe plaque psoriasis: a meta-analysis of randomized clinical trials. Ther Adv Chronic Dis 2023; 14:20406223231163110. [PMID: 37051072 PMCID: PMC10084576 DOI: 10.1177/20406223231163110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/24/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits both interleukin (IL)-17A and IL-17F, and is a promising drug for patients with moderate-to-severe plaque psoriasis. Objectives: This study aimed to assess the efficacy and safety of bimekizumab in treating patients with psoriasis and to determine the optimal maintenance dosing schedules of bimekizumab. Methods and design: Eligible trials were identified from PubMed, Cochrane Controlled Register of Trials, Embase, ClinicalTrials.gov, and Chinese medical databases. Only double-blind, randomized, active comparator, or placebo-controlled trials of bimekizumab treatment on patients with psoriasis were included in this study. Results: Five studies were identified, which included 2473 patients with moderate-to-severe plaque psoriasis. The results indicated that bimekizumab had better efficacy than placebo or active comparator for Psoriasis Area and Severity Index (PASI) 90 [risk ratio (RR) = 29.29, 1.52; 95% confidence interval (CI) = 10.30–83.30, 1.06–2.19], PASI 100 (RR = 59.87, 2.06; 95% CI = 15.06–237.99, 1.12–3.79), and Investigator’s Global Assessment scores of 0 or 1 (IGA 0/1) (RR = 21.55, 1.36; 95% CI = 9.25–50.19, 1.02–1.81). Faster onset of clinically meaningful responses was observed with bimekizumab compared with both active comparators (RR = 2.59; 95% CI = 1.32–5.10) and placebo (RR = 40.46; 95% CI = 13.19–124.13), with PASI 75 response observed at week 4 after one dose. Subgroup analysis showed no significant difference in the reduction of PASI scores between 320 mg q4w dosage and q8w dosage (RR = 1.00; 95% CI = 0.96–1.03). Rates of patients with adverse events (AEs) were comparable in the bimekizumab and active comparator groups (RR = 1.13; 95% CI = 1.01–1.26), and oral candidiasis was one of the most common treatment-emergent AEs. Conclusion: The results of this meta-analysis suggest that bimekizumab is more efficacious and has a rapid onset of action than active comparators and placebo in the treatment of moderate-to-severe plaque psoriasis. After 16 weeks of initial maintenance treatment, both bimekizumab maintenance dosing schedules (320 mg every 4 and 8 weeks) had similar efficacy.
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Affiliation(s)
- Yuqian Wang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Juan Bai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiaoxuan Cai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Peiyi Lin
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Qingmiao Sun
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310000, People’s Republic of China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310000, People’s Republic of China
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Santos-Moreno P, Sánchez-Vanegas G, Monterrosa-Blanco A, Rodríguez-Vargas GS, Rivero M, Rodriguez P, Calixto OJ, Rojas-Villarraga A, Castro CA. Adherence to Subcutaneous Anti-Tumour Necrosis Factor Treatment in a Cohort of Patients with Rheumatoid Arthritis Before and After the Implementation of a Comprehensive Care Model. Biologics 2022; 16:199-209. [PMID: 36440060 PMCID: PMC9699109 DOI: 10.2147/btt.s385422] [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: 08/08/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM). PATIENTS AND METHODS An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar's Chi2 test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure. RESULTS A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found. CONCLUSION A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.
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Affiliation(s)
| | - Guillermo Sánchez-Vanegas
- Scientific Direction Department, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia
| | - Angélica Monterrosa-Blanco
- Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia
| | | | - Manuel Rivero
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
| | | | - Omar-Javier Calixto
- Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia
| | | | - Carlos Alberto Castro
- Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia
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Usage and Adherence of Seven Advanced Therapies with Differing Mechanisms of Action for Inflammatory Arthritis in Canada. Rheumatol Ther 2022; 9:1399-1420. [PMID: 36045308 PMCID: PMC9510085 DOI: 10.1007/s40744-022-00485-2] [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: 03/11/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction This retrospective, observational study aimed to analyze and assess adherence, persistence, dosing, and use of concomitant medications of seven self-administered target drugs (abatacept, golimumab, secukinumab, tocilizumab, ustekinumab, apremilast, and tofacitinib) that are currently available in Canada for the treatment of inflammatory arthritis (IA). Methods We used IQVIA’s longitudinal claims databases, which include private drug plans and public plans. Patients with IA identified using a proprietary indication algorithm who initiated treatment with any of the target drugs between January 2015 and February 2019 were selected and followed for 12 months. Results Golimumab and apremilast had the highest proportion of patients (~ 75%) who were bio-naïve and secukinumab had the fewest bio-naïve patients (~ 43%). The oral therapies, apremilast and tofacitinib, had the lowest percentage of adherent patients (73% and 71%) followed by abatacept (83%), while the remaining drugs had adherence around 90%. Secukinumab and tofacitinib had the highest 12-month persistence rate (63% and 61%), while abatacept and apremilast had the lowest persistence rate (52% and 47%). Oral corticosteroid (OCS) use was not significantly associated with adherence. Tocilizumab, secukinumab, and ustekinumab had the highest proportion of patients (> 20%) with dose escalation at 3–4 months from index. OCS and conventional disease-modifying antirheumatic drugs (cDMARD) use decreased in post-index period across all target drugs. Conclusion This study identified substantial differences in patient baseline characteristics. Patients on injectable biologics were more likely to be adherent compared with those on oral drugs, possibly owing to longer dosing intervals. Other outcomes at 12 months appeared similar as evidenced by tapering of concomitant medications, although differences in persistence and dose escalation were noted.
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Huang JY, Leong PY, Ker A, Chen HH, Wei JCC, Ying LP. The long-term persistence of tumor necrosis factor inhibitors in patients with moderate to severe immune-mediated rheumatic diseases: A nation-wide, population-based real-world study. Int J Rheum Dis 2022; 25:1295-1305. [PMID: 35975402 DOI: 10.1111/1756-185x.14423] [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: 07/04/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to compare the long-term persistence between different tumor necrosis factor-alpha inhibitors (TNFis) with immune-mediated rheumatic diseases (IMRD). This study can potentially provide insights into the real-world evidence regarding safety and effectiveness of TNFi treatment in a Chinese population. METHODS We enrolled newly diagnosed IMRD patients in this active comparator, retrospective cohort study by using National Taiwan insurance claim datasets. The drug survivals of first-line TNFi agents, including etanercept, golimumab, and adalimumab were compared. Propensity score matching was conducted to control the confounding effect from the observed covariates. The cumulative proportion of discontinuation was calculated over 5 years. The multiple-variable regression and propensity score analysis was used for confounding adjustment. RESULTS After propensity score matching, there were 2267 patients identified in each etanercept, golimumab, and adalimumab group. We observed the 5-year cumulative proportion of discontinuation was 52.80%, 45.85%, and 56.86% in etanercept, golimumab, and adalimumab, respectively. Compared with golimumab, increase of 31% (95% CI: 20-43) and 38% (95% CI: 26-50) risk of discontinuation were observed in etanercept and adalimumab. The factors including female gender, increasing age, long hospital stays, without co-medication with nonsteroidal anti-inflammatory drugs or methotrexate were associated were discontinuation of first-line TNFi treatment. CONCLUSION Golimumab had better drug survival than etanercept or adalimumab over 5 years of observation in Asian IMRD patients. Gender, age, longer hospital stays, concomitant use of disease-modifying antirheumatic drugs were associated with survival with TNFis.
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Affiliation(s)
- Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pui-Ying Leong
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Amy Ker
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Leong-Pui Ying
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022. [DOI: 10.1007/s12325-021-01990-6
expr 982114691 + 941296860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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7
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022; 39:2342-2364. [PMID: 34988877 PMCID: PMC8731678 DOI: 10.1007/s12325-021-01990-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has prompted significant changes in patient care in rheumatology and gastroenterology, with clinical guidance issued to manage ongoing therapy while minimising the risk of nosocomial infection for patients and healthcare professionals (HCPs). Subcutaneous (SC) formulations of biologics enable patients to self-administer treatments at home; however, switching between agents may be undesirable. CT-P13 SC is the first SC formulation of infliximab that received regulatory approval and may be termed a biobetter as it offers significant clinical advantages over intravenous (IV) infliximab, including improved pharmacokinetics and a convenient mode of delivery. Potential benefits in terms of reduced immunogenicity have also been suggested. With a new SC formulation, infliximab provides an additional option for dual formulation, which enables patients to transition from IV to SC administration route without changing agent. Before COVID-19, clinical trials supported the efficacy and safety of switching from IV to SC infliximab for patients with rheumatoid arthritis and inflammatory bowel disease (IBD), and SC infliximab may have been selected on the basis of patient and HCP preferences for SC agents. During the pandemic, patients with rheumatic diseases and IBD have successfully switched from IV to SC infliximab, with some clinical benefits and high levels of patient satisfaction. As patients switched to SC therapeutics, the reduction in resource requirements for IV infusion services may have been particularly welcome given the pandemic, facilitating reorganisation and redeployment in overstretched healthcare systems, alongside pharmacoeconomic benefits and a reduction in exposure to nosocomial infection. Telemedicine and contactless healthcare have been pushed to the forefront during the pandemic, and a lasting shift towards remote patient management and community/home-based drug administration is anticipated. SC infliximab supports the implementation of this paradigm for future improvements of healthcare value delivered. The accumulation of real-world data during the pandemic supports the high level of confidence, with patients, physicians, and healthcare systems benefitting from its uptake.
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Affiliation(s)
- Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Rieke Alten
- Department of Internal Medicine II, Rheumatology, Clinical Immunology, Osteology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - Yoorim An
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Dong-Hyeon Kim
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Carballo N, Garcia-Alzórriz E, Ferrández O, Navarrete-Rouco ME, Durán-Jordà X, Pérez-García C, Monfort J, Cots F, Grau S. Impact of Non-Persistence on Healthcare Resource Utilization and Costs in Patients With Immune-Mediated Rheumatic Diseases Initiating Subcutaneous TNF-Alpha Inhibitors: A Before-and-After Study. Front Pharmacol 2021; 12:752879. [PMID: 34912219 PMCID: PMC8667555 DOI: 10.3389/fphar.2021.752879] [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: 08/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are chronic progressive immune-mediated rheumatic diseases (IMRD) that can cause a progressive disability and joint deformation and thus can impact in healthcare resource utilization (HCRU) and costs. The main outcome of the study was to assess the effect of non-persistence to treatment with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) on HCRU costs in naïve patients with IMRD who started treatment with adalimumab, etanercept, golimumab or certolizumab pegol during 12 months after initiation of treatment. The impact of persistence and non-persistence of SC-TNFis on HCRU costs was compared between 12 months before and 12 months after initiating SC-TNFis. Persistence was defined as the duration of time from initiation to discontinuation of therapy. The study was conducted in an acute care teaching hospital in Barcelona, Spain. Data for the period between 2015 and 2018 were extracted from the hospital cost management control database. HCRU costs comprised outpatient care, outpatient specialized rheumatology care, in-patient care, emergency care, laboratory testing and other non-biological therapies. The study population included 110 naïve SC-TNFis patients, divided into the cohorts of persistent (n = 85) and non-persistent (n = 25) patients. Fifty-six percent of patients were women, with a mean (standard deviation) age of 47.6 (14.8) years. Baseline clinical features and HCRU costs over the 12 months before the index prescription were similar in the two study groups. Before-and-after differences in mean (standard deviation) HCRU costs were significantly higher in the non-persistence group as compared to the persistence group for outpatient rheumatology care (€110.90 [234.56] vs. €20.80 [129.59], p = 0.023), laboratory testing (−€193.99 [195.88] vs. −€241.3 [217.88], p = 0.025), other non-biological drugs (€3849.03 [4046.14] vs. −€10.90 [157.42], p < 0.001) and total costs (€3268.90 [4821.55] vs. −€334.67 (905.44), p < 0.001). Treatment persistence with SC-TNFis may be associated with HCRU cost savings in naïve IMRD patients. Prescribing SC-TNFis with the best long-term persistence is beneficial.
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Affiliation(s)
- Nuria Carballo
- Pharmacy Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Olivia Ferrández
- Pharmacy Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Xavier Durán-Jordà
- Methodology and Biostatistics Support Unit, Institute Hospital del Mar for Medical Research (IMIM), Barcelona, Spain
| | | | - Jordi Monfort
- Department of Rheumatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
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Oliver R, Krueger JG, Glatt S, Vajjah P, Mistry C, Page M, Edwards H, Garcet S, Li X, Dizier B, Maroof A, Watling M, El Baghdady A, Baeten D, Ionescu L, Shaw S. Bimekizumab for the treatment of moderate-to-severe plaque psoriasis: efficacy, safety, pharmacokinetics, pharmacodynamics and transcriptomics from a phase IIa, randomized, double-blind multicentre study. Br J Dermatol 2021; 186:652-663. [PMID: 34687214 PMCID: PMC9303624 DOI: 10.1111/bjd.20827] [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] [Accepted: 10/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bimekizumab is a monoclonal antibody that selectively inhibits both interleukin (IL)-17A and IL-17F, which is currently under investigation for treatment of moderate-to-severe plaque psoriasis. Maintenance dosing every 4 weeks is well established with IL-17 inhibitors for psoriasis. OBJECTIVES To investigate the possible dosing interval during bimekizumab maintenance therapy to maintain clear skin, to inform phase III studies. METHODS Forty-nine patients with moderate-to-severe plaque psoriasis received bimekizumab 320 mg at weeks 0/4, followed at week 16 by bimekizumab 320 mg (n = 17) or placebo (n = 32). Efficacy, safety, pharmacokinetics, immunogenicity and biopsy transcriptomic analyses were assessed to week 28. RESULTS At week 8, 47% of patients achieved a 100% improvement from baseline in Psoriasis Area and Severity Index (PASI 100), increasing to 57% at week 12 (8 weeks after the second dose) before decreasing. In those who received bimekizumab at week 16, PASI 100 rate increased to comparable peak levels at week 20, but reduced by week 28 to 41% (12 weeks after the third dose). The week 8 transcriptional signature observed in lesional psoriatic skin rapidly normalized to levels consistent with nonlesional skin, resulting in molecular remission. Keratinocyte-related gene products such as CXCL1 (C-X-C motif chemokine ligand 1), IL-8 (encoded by the CXCL8 gene), CCL20 (C-C motif chemokine 20), IL-36γ and IL-17C were profoundly normalized to levels associated with nonlesional skin. CONCLUSIONS Here, inhibition of IL-17F in addition to IL-17A resulted in rapid, deep clinical responses. Additionally, profound normalization of keratinocyte biology and the psoriatic transcriptome was observed, including normalization of both IL17 and IL23 gene expression by week 8. These data provide evidence to support evaluation of bimekizumab maintenance dosing both every 8 and every 4 weeks in phase III clinical trials.
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Affiliation(s)
| | - J G Krueger
- The Rockefeller University, New York, NY, USA
| | | | | | - C Mistry
- UCB Pharma, Slough, UK.,Veramed, London, UK
| | | | | | - S Garcet
- The Rockefeller University, New York, NY, USA
| | - X Li
- The Rockefeller University, New York, NY, USA
| | - B Dizier
- UCB Pharma, Braine-l'Alleud, Belgium
| | | | | | - A El Baghdady
- Institute of Pharmaceutical Science, King's College London, London, UK
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Byun HG, Jang M, Yoo HK, Potter J, Kwon TS. Budget Impact Analysis of the Introduction of Subcutaneous Infliximab (CT-P13 SC) for the Treatment of Rheumatoid Arthritis in the United Kingdom. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:735-745. [PMID: 34383287 DOI: 10.1007/s40258-021-00673-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND CT-P13 subcutaneous (SC)-the first and only SC version of infliximab-is approved by the European Medicines Agency for the treatment of rheumatoid arthritis (RA). This new mode of infliximab administration will allow patients to self-inject at home, significantly reducing the number of outpatient visits and costs of intravenous (IV) administration. This paper describes the economic impact of introducing CT-P13 SC to the market from the UK societal perspective. OBJECTIVE The budget impact analysis was conducted to assess the financial impact of the adoption of CT-P13 SC over a 5-year period. METHODS A prevalence-based budget impact model was developed incorporating epidemiological data, administration cost data, and market share data. The analysis compared a "world with" CT-P13 SC scenario to a "world without" CT-P13 SC. A sensitivity analysis included dose escalation up to 4.1 mg/kg to reflect the real-world care delivery setting. RESULTS Compared to the "world without" scenario, the introduction of CT-P13 SC resulted in cost savings of ₤69.3 million in the UK over a 5-year period. In the scenario analysis, the saving increased to ₤173.5 million over 5 years. CONCLUSION Use of CT-P13 SC may lead to substantial cost savings for the UK society.
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Affiliation(s)
- Han Geul Byun
- Celltrion Healthcare, 19, Academy-ro 51, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - Minyoung Jang
- Celltrion Healthcare, 19, Academy-ro 51, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - Hyun Kyeong Yoo
- Celltrion Healthcare, 19, Academy-ro 51, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - James Potter
- Celltrion Healthcare United Kingdom Limited, 1-7 The Switch, The Grove, Slough, UK
| | - Taek Sang Kwon
- Celltrion Healthcare, 19, Academy-ro 51, Yeonsu-gu, Incheon, 22014, Republic of Korea.
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Ottaviani S, Forien M. [Compliance with biologic agents: Current situation]. Rev Mal Respir 2021; 38:698-705. [PMID: 34140211 DOI: 10.1016/j.rmr.2021.06.001] [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: 02/16/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
Despite the fact that the prognosis of chronic inflammatory disorders is improved by biological agents, compliance with those therapeutics remains imperfect. Compliance corresponds to the measurable part of the follow-up of the medical prescription by the patient, whereas adherence is related to the acceptation of the treatment by the patient. The compliance rates of biologic agents are generally higher than those of conventional therapies. Compliance can be influenced by the real or experienced efficacity of the treatment, by patient-related factors or by the patient-physician relationship. An increase of compliance is associated with an improvement of adherence. To achieve this, the physician can use educational measures such as patient education, which allows the identification of poor adherence. Such programs have been shown to improve the patient's knowledge of the disease and treatment leading to better adherence and compliance.
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Affiliation(s)
- S Ottaviani
- Service de rhumatologie, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - M Forien
- Service de rhumatologie, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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12
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Souza AF, Silva MRD, Santos JBD, Almeida AM, Acurcio FA, Alvares-Teodoro J. Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study. Pharm Pract (Granada) 2021; 19:2312. [PMID: 34221199 PMCID: PMC8216708 DOI: 10.18549/pharmpract.2021.2.2312] [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: 02/01/2021] [Accepted: 05/02/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Pharmaceutical services in Brazil provide access, supply, and rational use of
drugs for all population and an effort has been made to improve the quality
of these services. Biological drugs are high-cost drugs supplied in Brazil
that can inhibit disease progression and improve the quality of life of
psoriatic arthritis (PsA) patients. However, some patients did not achieve
therapeutic goals. Objective: To evaluate the medication adherence and persistence of PsA patients treated
with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated
factors. Methods: A prospective observational study was performed at a single-specialty
pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and
clinical outcomes were evaluated at 12 months of follow-up. Medication
persistence was historically compared to overall PsA patients treated in
Brazil. Associated factors were identified through log-binomial
regression. Results: One hundred ninety-seven PsA patients were included in the study, of whom 147
(74.6%) and 142 (72.1%) had medication adherence and
persistence, respectively. Patients treated with infliximab presented the
highest adherence (90.5%) and persistence rate (95.2%) in
comparison to patients treated with other drugs, except for adalimumab
versus infliximab for adherence outcome. All clinical measures significantly
improved in patients with medication adherence and persistence. Medication
persistence was higher for patients attended by specialty pharmacy than
other PsA patients in Brazil. The associated factors to higher medication
adherence were lower disease activity by BASDAI, being non-white race, and
intravenous drug use. The associated factors to higher medication
persistence were lower disease activity by Bath Ankylosing Spondylitis
Activity Index (BASDAI), intravenous drug use, non-use of corticoids and
non-steroidal anti-inflammatory drugs, and comorbidity. Conclusions: Patients with medication adherence and persistence had significant
improvements in clinical measures, functionality, and quality of life. High
medication adherence and persistence to biological therapy were observed and
associated with lesser disease activity at baseline. Also, medication
persistence to PsA patients attended in specialty pharmacy was higher than
the overall PsA population in Brazil, which indicates the importance of
pharmaceutical services to provide health care and promote the effectiveness
and safety of biological therapies.
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Affiliation(s)
- Ana F Souza
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
| | - Michael R Da Silva
- PhD. Professor. Department of Pharmacy and Nutrition; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, ES (Brazil).
| | - Jéssica B Dos Santos
- PhD. Department of Pharmacy and Nutrition; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, ES (Brazil).
| | - Alessandra M Almeida
- PhD. Professor. Faculty of Medical Sciences of Minas Gerais. Belo Horizonte, MG (Brasil).
| | - Francisco A Acurcio
- PhD. Professor. Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
| | - Juliana Alvares-Teodoro
- PhD. Professor. Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
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13
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Pombo-Suarez M, Sanchez-Piedra C, Garcia-Magallón B, Pérez-Gómez A, Manrique-Arija S, Martín-Doménech R, Colazo M, Campos C, Campos J, Del Pino-Montes J, Arteaga MJ, Cea-Calvo L, Díaz-González F, Gómez-Reino JJ. Factors associated with long-term retention of treatment with golimumab in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis: an analysis of the Spanish BIOBADASER registry. Clin Rheumatol 2021; 40:3979-3988. [PMID: 33907904 DOI: 10.1007/s10067-021-05742-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retention of biological treatment provides a marker of drug effectiveness and patient satisfaction. Retention of golimumab was high in clinical trial extensions and real-world studies up to 5 years in patients with immune-mediated rheumatic diseases. OBJECTIVE To assess the probability of real-world long-term retention of treatment with golimumab up to 7 years after treatment initiation. METHODS This retrospective noninterventional study involved analysis of the Spanish biological drugs registry, BIOBADASER. Adults who had ever received golimumab for rheumatoid arthritis (RA), axial spondyloarthritis (SpA), or psoriatic arthritis (PsA), and had initiated it > 6 months before the analysis date, were included. RESULTS Among 685 patients (28.5% RA, 42.9% SpA, 28.6% PsA), the overall probability of retention of golimumab treatment since initiation was 71.7% (95% confidence interval 68.1-74.9) at year 1, 60.5% (56.5-64.2%) at year 2, 55.6% (51.5-59.5%) at year 3, 50.6% (46.2-54.8%) at year 4, 45.1% (40.1-50.0%) at year 5, 44.2% (39.0-49.3) at year 6, and 39.5% (32.8-46.2) at year 7. Retention was greater in patients with axial SpA or PsA versus RA (p < 0.001) and when golimumab was used as first-line treatment versus third or later lines (p < 0.001). Factors associated with greater golimumab retention in Cox regression included use as first-line biological therapy, having axial SpA or PsA rather than RA, and concomitant methotrexate therapy. Steroids were associated with lower retention. CONCLUSION In this real-world study of RA, axial SpA, and PsA patients, the retention rate of golimumab was 39.5% at year 7. Key Points • Retention of biological treatment provides a marker of drug effectiveness and patient satisfaction. • This real-world study of 685 patients with rheumatoid arthritis (RA), axial spondyloarthritis (SpA), or psoriatic arthritis (PsA) showed that golimumab treatment had a retention rate up to 39.5% at year 7. • Greater golimumab retention was associated with use as first-line biological therapy, having axial SpA or PsA rather than RA, and concomitant methotrexate therapy.
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Affiliation(s)
- Manuel Pombo-Suarez
- Department of Rheumatology, Hospital Universitario de Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain.
| | | | | | - Ana Pérez-Gómez
- Department of Rheumatology, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - María Colazo
- Department of Rheumatology, Hospital Universitario de Burgos, Burgos, Spain
| | - Cristina Campos
- Department of Rheumatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - José Campos
- Department of Rheumatology, Hospital Puerta de Hierro, Madrid, Spain
| | - Javier Del Pino-Montes
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Federico Díaz-González
- Department of Rheumatology, Hospital Universitario de Canarias, Sta Cruz de Tenerife, Spain
| | - Juan J Gómez-Reino
- Department of Rheumatology, Hospital Universitario de Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
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14
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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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15
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Núñez-Rodríguez J, González-Pérez Y, Nebot-Villacampa M, Zafra-Morales R, Obaldia-Alaña M, Caso-González A. Adherencia terapéutica a fármacos biológicos en pacientes con artritis reumatoide, artritis psoriásica y espondilitis anquilosante. (Estudio ADhER-1). Semergen 2021; 47:81-90. [DOI: 10.1016/j.semerg.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
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16
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Nieto JC, Arajol C, Carmona L, Marras C, Cea-Calvo L. Adherence to subcutaneous biological therapies in patients with inflammatory rheumatic diseases and inflammatory bowel disease: a systematic review. Immunotherapy 2021; 13:433-458. [PMID: 33557600 DOI: 10.2217/imt-2021-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: To assess adherence to subcutaneous biologicals in adults with inflammatory rheumatic diseases or inflammatory bowel disease and evaluate factors possibly associated with adherence. Materials & methods: Systematic searches were conducted of main databases from January 2000 to June 2019. Results: 41 articles (32 full papers and nine abstracts) were included in the review. Among studies which used a medication possession ratio threshold of ≥80% as the end point, adherence varied from 28.8 to 89.4%. Possible predictors of adherence were older age, professional or family member support, belief in medication necessity, lower concerns about medication and monthly versus weekly administration. Conclusion: Considerable variability in adherence rates across published studies reflects study heterogeneity and the absence of a 'gold standard' to measure adherence.
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Affiliation(s)
- Juan C Nieto
- Department of Rheumatology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Claudia Arajol
- Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Carlos Marras
- Department of Rheumatology, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
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17
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Gordon KB, Foley P, Krueger JG, Pinter A, Reich K, Vender R, Vanvoorden V, Madden C, White K, Cioffi C, Blauvelt A. Bimekizumab efficacy and safety in moderate to severe plaque psoriasis (BE READY): a multicentre, double-blind, placebo-controlled, randomised withdrawal phase 3 trial. Lancet 2021; 397:475-486. [PMID: 33549192 DOI: 10.1016/s0140-6736(21)00126-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A. This study investigated the efficacy and safety of bimekizumab in patients with moderate to severe plaque psoriasis, the effects of treatment withdrawal, and two maintenance dosing schedules over 56 weeks. METHODS BE READY was a phase 3, multicentre, randomised, double-blind, placebo-controlled trial done at 77 sites (hospitals, clinics, private doctor's practices, and dedicated clinical research centres) in nine countries across Asia, Australia, Europe, and North America. Adult patients aged 18 years or older with moderate to severe plaque psoriasis were stratified by region and previous biologic exposure, and randomly assigned (4:1) to receive bimekizumab 320 mg every 4 weeks or placebo every 4 weeks by use of interactive response technology. Coprimary endpoints were the proportion of patients achieving 90% or greater improvement from baseline in the Psoriasis Area Severity Index (PASI90) and the proportion of patients achieving a score of 0 (clear) or 1 (almost clear) on the five-point Investigator's Global Assessment (IGA) scale at week 16 (non-responder imputation). Bimekizumab-treated patients achieving PASI90 at week 16 were re-allocated (1:1:1) to receive bimekizumab 320 mg every 4 weeks, every 8 weeks, or placebo for weeks 16-56. Efficacy analyses were done in the intention-to-treat population; the safety analysis set comprised all patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov (NCT03410992), and is now completed. FINDINGS Between Feb 5, 2018, and Jan 7, 2020, 435 patients were randomly assigned to receive either bimekizumab 320 mg every 4 weeks (n=349) or placebo every 4 weeks (n=86). Coprimary endpoints were met: at week 16, 317 (91%) of 349 patients receiving bimekizumab 320 mg every 4 weeks achieved PASI90, compared with one (1%) of 86 patients receiving placebo (risk difference 89·8 [95% CI 86·1-93·4]; p<0·0001); and 323 (93%) of 349 patients receiving bimekizumab 320 mg every 4 weeks achieved an IGA score of 0 or 1 versus one (1%) of 86 patients receiving placebo (risk difference 91·5 [95% CI 88·0-94·9]; p<0·0001). Responses were maintained through to week 56 with bimekizumab 320 mg every 8 weeks and every 4 weeks. Treatment-emergent adverse events in the initial treatment period (up to week 16) were reported in 213 (61%) of 349 patients receiving bimekizumab 320 mg every 4 weeks and 35 (41%) of 86 patients receiving placebo every 4 weeks. From week 16 to week 56, treatment-emergent adverse events were reported in 78 (74%) of 106 patients receiving bimekizumab 320 mg every 4 weeks, 77 (77%) of 100 patients receiving bimekizumab 320 mg every 8 weeks, and 72 (69%) of 105 patients receiving placebo. INTERPRETATION Bimekizumab showed high levels of response, which were durable over 56 weeks, with both maintenance dosing schedules (every 4 weeks and every 8 weeks). Moreover, bimekizumab was well tolerated, with no unexpected safety findings. Data presented here further support the therapeutic value of bimekizumab and inhibition of IL-17F in addition to IL-17A for patients with moderate to severe plaque psoriasis. FUNDING UCB Pharma.
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Affiliation(s)
- Kenneth B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Peter Foley
- Skin Health Institute, Carlton, and The University of Melbourne, Parkville, VIC, Australia
| | | | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Vender
- Division of Dermatology, McMaster University, Hamilton, ON, Canada
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Abdul Razak S, Makmor Bakry M, Mohamed Said MS, Tan CE, Md Redzuan A. Development and Validation of Adherence Score for Subcutaneous Biologic Disease-Modifying Antirheumatic Drugs. Front Pharmacol 2020; 11:572260. [PMID: 33240088 PMCID: PMC7681069 DOI: 10.3389/fphar.2020.572260] [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: 06/13/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The biologic disease-modifying antirheumatic drugs (bDMARDs) are currently incorporated as part of the pharmacotherapy management of inflammatory arthritis (IA). Adherence to bDMARDs is crucial to ensure treatment success in IA. However, most of the recent studies evaluated adherence level in patients using subcutaneous injections of bDMARDs utilized the indirect methods adapted from adherence assessment for oral medication. Aim: This study aimed to develop a questionnaire to assess adherence to the self-injectable subcutaneous bDMARDs. Methods: The development of the Subcutaneous bDMARDs Adherence Score (SCADS) involved evaluation of content validity. Literature reviews provide the basis for domain identification and item formation. Four experts evaluated the instrument by using a four-point ordinal scale with a rubric scoring on relevance, importance, and clarity of each item in measuring the overarching construct. The item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI) were calculated. The factor structure and internal consistency reliability of SCADS were estimated using principal component analysis (PCA) and Cronbach's alpha, respectively. Results: Both S-CVI/UA (universal agreement) and the average item-level content validity index (S-CVI/Ave) (average) for the entire instrument showed excellent criteria with a value of >0.90. Cronbach's alpha coefficient value for SCADS was 0.707 indicating good internal consistency. All items showed corrected item-total correlation coefficients above 0.244. Questionnaire items with a factor loading of 0.30 or above were considered in the final factor solution. The factor analysis resulted in 3-factor solutions, which corresponded to 66.62% of the total variance. Conclusion: The SCADS is a consistent and reliable instrument for evaluating adherence among IA patients using the subcutaneous bDMARDs. It is simple to use, yet comprehensive but still requiring further clinical and international validation.
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Affiliation(s)
- Salmi Abdul Razak
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Mohd Makmor Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Chai-Eng Tan
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Pompilus F, Ciesluk A, Strzok S, Ciaravino V, Harris K, Szegvari B, Mountian I, Cleanthous S, Meunier J. Development and psychometric evaluation of the assessment of self-injection questionnaire: an adaptation of the self-injection assessment questionnaire. Health Qual Life Outcomes 2020; 18:355. [PMID: 33148261 PMCID: PMC7640481 DOI: 10.1186/s12955-020-01606-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/22/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) instruments provide robust and effective means of evaluating patients' treatment experience; however, none adequately cover experience using self-injection devices with enhanced features, such as an electromechanical autoinjector (e-Device). The aim of this study was to develop a PRO instrument that accurately assesses patient experience of using an e-Device and to evaluate its psychometric properties. METHODS A mixed-methods approach was taken; two parallel, targeted literature reviews were conducted to identify relevant concepts and existing self-injection PRO instruments that could be adapted. Patient feedback obtained from two focus groups was used to inform initial instrument development. The pilot instrument was then administered in a multicenter, open-label, phase 3 clinical study in which patients self-injected certolizumab pegol using an e-Device, to gather evidence of its psychometric qualities. Exit interviews were conducted with a sub-sample of patients enrolled in the study to confirm the appropriateness and clarity of the items included and cognitively debrief the instrument. Confirmatory factor analysis (CFA) was conducted on all items, and each domain's internal consistency was measured using Cronbach's ɑ. RESULTS The literature searches identified several e-Device-specific concepts related to device features, device function, side effects/reactions/pain, confidence, and interference/convenience in daily life. Seven existing PRO instruments were identified. The Self-Injection Assessment Questionnaire (SIAQ), containing pre- and post-injection questionnaire modules, was selected as most suitable and adapted using feedback from 19 patients in the two focus groups to form the pilot Assessment of Self-Injection (ASI) questionnaire. CFA resulted in some changes to the grouping of items in the post-injection module domains following psychometric evaluation of the ASI. Internal consistency was satisfactory for all pre- and post-injection domains (ɑ > 0.8). Cognitive debriefing results from 12 patient exit interviews confirmed the ASI's appropriateness and clarity. CONCLUSIONS The ASI was developed iteratively with patient input and was evaluated in its intended clinical context of use. Psychometric analyses indicated promising cross-sectional results; the ASI was well understood and considered relevant by patients self-injecting using the e-Device, suggesting that it could be used in real-world settings to aid with clinical decision making. TRIAL REGISTRATION NCT03357471.
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Affiliation(s)
| | | | - Sara Strzok
- Modus Outcomes, 1 Broadway, Cambridge, MA, USA
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20
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Lee JK, Amin S, Erdmann M, Kukaswadia A, Ivanovic J, Fischer A, Gendron A. Real-World Observational Study on the Characteristics and Treatment Patterns of Allergic Asthma Patients Receiving Omalizumab in Canada. Patient Prefer Adherence 2020; 14:725-735. [PMID: 32308377 PMCID: PMC7152735 DOI: 10.2147/ppa.s248324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/10/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Omalizumab is a treatment option for pediatric and adult patients with moderate to severe allergic asthma poorly controlled with standard inhaled therapies. Clinical trials and observational studies have demonstrated the efficacy of omalizumab. There is limited real-world evidence on the characteristics and treatment patterns of Canadian asthma patients receiving omalizumab. OBJECTIVE We profiled Canadian omalizumab users to estimate time to omalizumab discontinuation and to assess changes in concurrent medication usage before, during, and after therapy. METHODS This was a retrospective, observational, cohort study that analyzed data from Canadian prescription claims databases. An algorithm was used to select naïve users of omalizumab with an inferred diagnosis of GINA 5-asthma who made a claim for omalizumab from February 1, 2007, to June 2, 2015. Demographic and baseline characteristics were assessed at index. Outcomes examined over the analysis period included (i) daily omalizumab dose per patient and per claim; (ii) omalizumab discontinuation (defined as ≥100-day gap in making omalizumab claims) and its potential predictors (ie, age, sex, province of residence, drug insurer; assessed by Cox Proportional Hazards Model); and (iii) for patients who discontinued omalizumab, changes in concurrent medication usage before, during, and 6 months after omalizumab usage. RESULTS The final study cohort consisted of 1160 patients (mean age: 45.8 ± 15.2 years; 64.7% female). During the first year of omalizumab therapy, 29.5% of patients discontinued treatment. The singular characteristic that predicted omalizumab discontinuation with statistical significance was age group (20‒34 years vs 12‒19 years; hazard ratio 1.75, 95% confidence interval 1.11-2.76; P<0.05). There were significant reductions in the use of some concurrent inhaled and oral asthma medications during and/or after omalizumab use (P<0.05). CONCLUSION Nearly one-third of patients who initiated omalizumab in Canada for refractory, moderate to severe allergic asthma discontinued treatment during the first year.
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Affiliation(s)
- Jason K Lee
- Clinical Immunology and Allergy, Internal Medicine, Evidence Based Medical Educator Inc. and Urticaria Canada, Toronto, ON, Canada
| | | | | | | | | | | | - Alain Gendron
- AstraZeneca, Mississauga, Ontario, Canada and Department of Medicine, Université de Montréal, Montreal, QC, Canada
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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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Esposito M, Carubbi F, Giunta A, Alunno A, Giacomelli R, Fargnoli MC. Certolizumab pegol for the treatment of psoriatic arthritis and plaque psoriasis. Expert Rev Clin Immunol 2020; 16:119-128. [PMID: 31917928 DOI: 10.1080/1744666x.2020.1713754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Certolizumab pegol (CZP) is an Fc-free PEGylated TNF-α inhibitor approved for the treatment of psoriatic arthritis (PsA) and plaque psoriasis in many countries. It demonstrated favorable results in PsA in terms of improvement in peripheral arthritis, dactylitis, and enthesitis in a phase III trial (RAPID-PSA) and in real-life experiences. Recently, three phase III randomized clinical trials (CIMPASI-1, CIMPASI-2, CIMPACT) showed significant and sustained improvements in signs and symptoms of moderate-to-severe plaque psoriasis as well as in quality of life parameters as compared to placebo and etanercept.Areas covered: We reviewed the structure and the mechanism of action of CZP, and critically analyzed data from clinical trials and real-life, concerning its efficacy and safety in all aspects of the psoriatic disease. We designed a comprehensive literature search on this topic, by a review of published articles in indexed international journals up until 31 July 2019.Expert opinion: CZP demonstrated positive results in several domains of psoriatic disease, also in patients previously exposed to other TNF-α inhibitors and in patients receiving re-treatment after treatment interruption. The peculiar chemical structure, along with its well-established efficacy and safety, support CZP as the drug of choice in specific subgroups of patients with psoriatic disease, in particular patients with comorbidities and pregnant or breastfeeding female patients.
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Affiliation(s)
- Maria Esposito
- Dermatology Unit, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy.,Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Alessandro Giunta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Dermatology Unit, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
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Alvarez-Madrazo S, Kavanagh K, Siebert S, Semple Y, Godman B, Maciel Almeida A, Acurcio FDA, Bennie M. Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study. BMJ Open 2019; 9:e027059. [PMID: 31488467 PMCID: PMC6731860 DOI: 10.1136/bmjopen-2018-027059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. DESIGN Retrospective cohort. SETTING Patients in secondary care receiving SC biologics in the largest Scottish Health Board. PARTICIPANTS A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. OUTCOMES MEASURED A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR). RESULTS 751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days' follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%). CONCLUSION Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.
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Affiliation(s)
- Samantha Alvarez-Madrazo
- Health Data Research Scotland, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- School of Public Health, Imperial College London, London, United Kingdom
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Yvonne Semple
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Medicines Information, Pharmacy Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | | | | | - Marion Bennie
- Health Data Research Scotland, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
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Luttropp K, Dozier M, Justo N, Cornillie F, Kachroo S, Govoni M, Salomonsson S, Black CM, Khalifa A. Real-world treatment persistence of golimumab in the management of immune-mediated rheumatic diseases in Europe: a systematic literature review. BMJ Open 2019; 9:e027456. [PMID: 31142529 PMCID: PMC6549706 DOI: 10.1136/bmjopen-2018-027456] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To summarise real-world data from studies reporting golimumab persistence in European immune-mediated rheumatic disease (IMRD) populations and to report pooled estimates. DESIGN Systematic literature review. DATA SOURCES Relevant literature was identified through searching Medline and Embase via Ovid as well as the conference databases of European League Against Rheumatism and American College of Rheumatology-Association of Rheumatology Health Professionals. ELIGIBILITY CRITERIA We screened records using predefined patients, interventions, comparators, outcomes and study design criteria. Eligible studies included reports of persistence among adult IMRD patients in Europe receiving treatment with subcutaneous golimumab. Clinical trials, randomised controlled trials, literature reviews, editorials, guidelines and studies with <20 patients receiving golimumab were excluded. DATA EXTRACTION AND SYNTHESIS Following double screening by two independent reviewers, 27 studies out of 578 identified records were selected for inclusion and subsequent data extraction. Persistence was most commonly reported at 12and 24 months; hence, pooled persistence estimates were calculated for these two time points and reported according to indication. RESULTS Persistence ranged between 58.1% (psoriatic arthritis (PsA) patients regardless of treatment line) and 75.7% (biological-naïve rheumatoid arthritis patients) at 12 months; at 24 months, the range was 43% (axial spondyloarthritis (AxSpA) patients regardless of treatment line) and 69.6% (biological-naïve PsA patients). On the basis of data from 12 studies, persistence with golimumab treatment was either significantly higher or not significantly different from other tumour necrosis factor inhibitors (TNFi). CONCLUSIONS Golimumab persistence at 24 months approximates 50%, with a lower persistence among AxSpA (43%) patients. However, as the number of studies in these populations was low, they warrant further research. In 12 studies comparing various TNFi treatments, golimumab was shown to have significantly better or equal persistence to its comparators.
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Affiliation(s)
- Karin Luttropp
- Real World Evidence Strategy & Analytics, ICON Clinical Research, Stockholm, Sweden
| | - Mary Dozier
- Real World Evidence Strategy & Analytics, ICON Clinical Research, Boston, Massachusetts, USA
| | - Nahila Justo
- Real World Evidence Strategy & Analytics, ICON Clinical Research, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Freddy Cornillie
- Medical Affairs Immunology, MSD Switzerland, Lucerne, Switzerland
| | - Sumesh Kachroo
- Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Stina Salomonsson
- Center for Observational and Real-world Evidence (CORE), MSD Sweden, Stockholm, Sweden
| | - Christopher M Black
- Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Ahmed Khalifa
- Medical Affairs Immunology, MSD Switzerland, Lucerne, Switzerland
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25
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Menzella F, Latorre M, Ruggiero P, Bagnasco D, Heffler E. Reduction of oral corticosteroids in patients with severe eosinophilic asthma treated with Benralizumab: could it represent a marker of treatment efficacy? Expert Opin Biol Ther 2019; 19:601-606. [PMID: 31033373 DOI: 10.1080/14712598.2019.1613367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Subjects with severe Th2-high endotype usually respond to oral corticosteroids (OCS). However, they often require high dosages with incremental side effects and health-care costs. The advent of biological therapies provides an effective strategy to improve asthma control, as well as reduce OCS use. Various molecules have been developed, each targeting different pathways. We analyzed the two anti-IL-5 strategies, benralizumab and mepolizumab, based on pivotal trials (RCTs), mechanisms of action and their possible role on the steroid-sparing effect. Areas covered: This review analyzes the data from the benralizumab and mepolizumab RCTs, focusing on the advantages of each drug on clinical efficacy and the steroid-sparing effect. Expert opinion: Benralizumab may represent a promising therapeutic option in the treatment of eosinophilic asthma, due to its mechanism of action, which rapidly allows a reduction in the eosinophils' number, and a greater steroid-sparing effect.
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Affiliation(s)
- Francesco Menzella
- a Department of Medical Specialties, Pneumology Unit , Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS , Reggio Emilia , Italy
| | - Manuela Latorre
- b Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| | - Patrizia Ruggiero
- a Department of Medical Specialties, Pneumology Unit , Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS , Reggio Emilia , Italy
| | - Diego Bagnasco
- c Allergy & Respiratory Diseases, DIMI Department of Internal Medicine , University of Genoa, IRCCS AOU San Martino-IST , Genoa , Italy
| | - Enrico Heffler
- d Personalized Medicine, Asthma and Allergy , Humanitas Research Hospital , Rozzano , Italy
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26
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Otón T, Carmona L, Urruticoechea-Arana A, Calvo-Alén J, Arteaga MJ, Cea-Calvo L. Discordance between doctor and patient assessments and non-adherence to subcutaneous biological drugs. Rheumatol Int 2019; 39:1077-1082. [DOI: 10.1007/s00296-019-04304-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Dos Santos JBR, Guerra Junior AA, da Silva MRR, Almeida AM, Acurcio FDA, Alvares-Teodoro J. First line of biological drugs in rheumatoid arthritis: a medication persistence analysis. Expert Rev Clin Pharmacol 2019; 12:363-370. [PMID: 30813823 DOI: 10.1080/17512433.2019.1586533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate the persistence of biological drugs used as the first line of biological treatment in patients diagnosed with rheumatoid arthritis. The predictors associated with persistence have also been verified. METHODS We evaluated a historical cohort composed of users of the Brazilian National Health System in the period between 2006 January and 2014 December. The endpoint was the medication persistence at 12 months. RESULTS A population composed of 66,787 individuals started the first line of biological drug. Out of such individuals, 34,595 (51.80%) persisted in the treatment at 12 months. Abatacept was the drug that presented higher persistence, followed by golimumab, tocilizumab, etanercept, and adalimumab and, with lower persistence certolizumab and infliximab. Younger individuals, living in regions with higher social inequality by Gini coefficient, using certolizumab and infliximab in comparison with adalimumab presented a higher risk of non-persistence to treatment. Individuals from the Southeastern region were more persistent than Northeastern, Central-western, Northern and Southern regions. CONCLUSION The medication persistence was different between biological drugs. The rigorous follow-up of patients, by a multidisciplinary team, is important to enable the development of strategies for the adequate use of such drugs.
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Affiliation(s)
| | - Augusto Afonso Guerra Junior
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | | | - Alessandra Maciel Almeida
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Francisco de Assis Acurcio
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil.,b Department of Social and Preventive Medicine, School of Medicine , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Juliana Alvares-Teodoro
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
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28
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Takacs P, Lathia U, Shin J, Nantel F. Persistence to subcutaneous biological agents in Hungarian patients treated for inflammatory arthritis. Patient Prefer Adherence 2019; 13:157-163. [PMID: 30697037 PMCID: PMC6342139 DOI: 10.2147/ppa.s186776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of the study was to compare drug survival rate of subcutaneous tumor necrosis factor alpha inhibitors in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis patients in Hungary. METHODS This was a retrospective analysis using data collected from 5,647 patients over a period of 10 years who were treated with any of the following drugs: adalimumab (ADA), etanercept, certolizumab pegol (CZP), and golimumab (GLM). National Health Insurance Fund's hospital, drug reimbursement, and special reimbursement registry data have been used in this study. Drug survival rate was calculated according to Kaplan-Meier survival analysis. Propensity score matching was used to reduce the potential bias caused by the inhomogeneity resulting from demographic characteristics, patient pathways, or drug administration protocols. Both raw and propensity matched data were subject of pairwise comparison between the four subcutaneous therapies. RESULTS The overall rate of persistence for the 4 biological therapies was between 53% and 61% after 1 year and between 14% and 19% after 4 years (follow-up time). Pairwise comparisons between therapies showed significant differences with GLM-treated patients showing longer median survival times than patients on other therapies. After propensity matching, these differences remained statistically significant between GLM and ADA or CZP over 4 years. CONCLUSION Hungarian show longer persistence to GLM compared to ADA and CZP.
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Affiliation(s)
| | - Urja Lathia
- Medical Affairs, Janssen Inc., Toronto, ON, Canada,
| | - Janey Shin
- Medical Affairs, Janssen Inc., Toronto, ON, Canada,
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29
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Acar M, Juneja P, Handel M. Treatment persistence of subcutaneous TNF inhibitors among Australian patients with immune-mediated rheumatic disease (IMRD). Open Access Rheumatol 2018; 10:151-160. [PMID: 30568519 PMCID: PMC6267492 DOI: 10.2147/oarrr.s179704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction To describe the persistence of treatment with subcutaneous tumor necrosis factor inhibitors (TNFi) adalimumab, etanercept, and golimumab in immune-mediated rheumatic disease (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) by treatment sequence (first-line treatment, second-line or further lines of treatment). Methods A retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme 10% sample data from January 1, 2010, to June 30, 2016. Pharmaceutical Benefits Scheme indications were used to identify patient prescriptions for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A patient was considered persistent until a 3-month gap period where a prescription was not dispensed. The 3-month gap interval was chosen because only 1% of all discontinuations occurred beyond this 3-month period. Results Data from 2,612 first-line patients were included. Treatment discontinuation among first-line patients treated with etanercept or adalimumab was not significantly different from those treated with golimumab (HR 1.10, 95% CI 0.95–1.28, P=0.22; HR 1.06, 95% CI 0.93–1.22, P=0.39; respectively). Among the 1,276 patients in the second-line cohort (etanercept=41%, adalimumab=41%, golimumab=18%) discontinuation was significantly higher for patients on etanercept compared with golimumab (HR 1.24, 95% CI 1.03–1.50, P=0.03); but not for adalimumab compared with golimumab (HR 1.11, 95% CI 0.91–1.34, P=0.31). In the third-line setting, treatment persistence with etanercept was longer than golimumab (HR 0.75, 95% CI 0.59–0.96, P=0.02), but there was no difference between golimumab and adalimumab. Similar findings occurred in the propensity score matched population. Conclusion Our study shows there is variance in real-world persistence to TNFi in patients with immune-mediated rheumatic disease by line of therapy, with the time on therapy decreasing by line. Australian persistence has been reported at lower overall rates than international evidence.
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30
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Vogelzang EH, Hebing RCF, Nurmohamed MT, van Kuijk AWR, Kruijff JWF, l'Ami MJ, Krieckaert CLM, Wolbink G. Adherence to etanercept therapy in rheumatoid arthritis patients during 3 years of follow-up. PLoS One 2018; 13:e0205125. [PMID: 30300358 PMCID: PMC6177149 DOI: 10.1371/journal.pone.0205125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/19/2018] [Indexed: 12/11/2022] Open
Abstract
Objectives To determine the percentage non-adherence to etanercept in patients with rheumatoid arthritis during three years of follow-up. Methods During study visits in this prospective cohort study, blood samples were taken to determine serum etanercept concentrations using ELISA and patients were asked if they had missed an etanercept dose, at which date and for what reason. Non-adherence was defined as serum etanercept concentration <0.1 μg/mL and no valid reason to miss the prescribed etanercept dose. Results In total, 292 consecutive patients treated with etanercept were included. Most patients had a valid reason to miss their etanercept dose (25/37). In total 12 out of 292 patients (4.1%, 95% confidence interval 2.2–7.2) were non-adherent during the 3 year period. In a small percentage of patients (3.4%, 95% confidence interval 0.8–10.4) who failed to respond to etanercept therapy, according to their rheumatologist, this was associated with inadequate exposure to etanercept and thus non-adherence. Conclusion In this study, adherence to etanercept therapy was measured using serum etanercept concentration. In most patients an absent etanercept concentration was due to a medical reason. Furthermore, the majority of patients were adherent to etanercept therapy and had adequate drug exposure. In total, only 12 out of 292 patients (4.1%) were non-adherent during 3 years of follow-up. These findings highlight that only a small minority of patients are non-adherent to etanercept treatment, especially compared to adherence rates of other drugs. However, physicians should be aware that in patients failing to respond to treatment, non-adherence is a possible cause.
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Affiliation(s)
- E H Vogelzang
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - R C F Hebing
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Pharmacy, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - A W R van Kuijk
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - J W F Kruijff
- University of Amsterdam, Faculty of Science, Amsterdam, The Netherlands
| | - M J l'Ami
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - C L M Krieckaert
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - G Wolbink
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands.,Sanquin Research and Landsteiner Laboratory, Immunopathology, Amsterdam, The Netherlands
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McCulley C, Katz P, Trupin L, Yelin EH, Barton JL. Association of Medication Beliefs, Self-efficacy, and Adherence in a Diverse Cohort of Adults with Rheumatoid Arthritis. J Rheumatol 2018; 45:1636-1642. [PMID: 30219761 DOI: 10.3899/jrheum.171339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) patients' adherence to disease-modifying antirheumatic drugs (DMARD) is often suboptimal. We examined associations among medication beliefs, self-efficacy, and adherence to medications in RA. METHODS Data were from a longitudinal observational cohort of persons with RA. Subjects completed telephone interviews on self-reported adherence, self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ), which assesses beliefs in necessity and beliefs about taking medication. Bivariate and multivariate logistic regression identified correlates of poor adherence to synthetic DMARD and prednisone as well as to biologic therapy, including medication concerns and necessity. RESULTS There were 362 patients who reported taking a synthetic DMARD and/or prednisone. Of these, 14% and 21% reported poor adherence to oral DMARD or prednisone, and biologics, respectively. There were 64% who reported concern about taking medicines, 81% about longterm effects, and 47% about becoming too dependent on medicines. In multivariate analyses, the BMQ necessity score was independently associated with better adherence to oral DMARD or prednisone (adjusted OR 0.61, 95% CI 0.41-0.91), while self-efficacy was associated with greater odds of poor adherence to oral medications (adjusted OR 1.23, 95% CI 1.01-1.59). Beliefs in medicines and self-efficacy were not associated with adherence to biologics. CONCLUSION In a diverse cohort of patients with RA, stronger beliefs in the necessity of medication were associated with better adherence to oral DMARD or prednisone, while higher self-efficacy was associated with poor adherence. Providers can play important roles in eliciting patient beliefs about medications to improve adherence and ultimately health outcomes.
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Affiliation(s)
- Caroline McCulley
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Patricia Katz
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Laura Trupin
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Edward H Yelin
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Jennifer L Barton
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA. .,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System.
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