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Alkaabi MMS, Rabbani SA, Rao PGM, Mohamedelhassan MI. Treatment patterns and factors associated with discontinuation of monoclonal antibodies. SAGE Open Med 2024; 12:20503121241271817. [PMID: 39165864 PMCID: PMC11334246 DOI: 10.1177/20503121241271817] [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: 04/02/2024] [Accepted: 07/03/2024] [Indexed: 08/22/2024] Open
Abstract
Background Biological agents have revolutionized care in specialties such as oncology, immunology, infectious diseases, and genetic disorders, offering targeted actions on specific molecules or select immune cells. Monoclonal antibodies, known for their high specificity and precision, represent one of the most significant and rapidly expanding categories of these agents. Understanding the drug utilization patterns of monoclonal antibodies is crucial to ensure their optimal use, especially given their high cost and potential adverse effects. Methods This analytical cross-sectional study was conducted in a secondary hospital in the United Arab Emirates. Patients of either gender receiving monoclonal antibodies at the study site were included. Treatment patterns, utilization, and factors associated with the discontinuation of monoclonal antibodies were assessed. Results Hyperlipidemia (136, 39.1%) was the most common indication for monoclonal antibodies, followed by prophylaxis of respiratory syncytial virus infection in congenital heart disease (104, 29.9%) and osteoporosis (42, 12.1%). Evolocumab was the most commonly prescribed monoclonal antibody (135, 38.8%), followed by palivizumab (104, 29.9%), and dupilumab (38, 10.9%). The majority of monoclonal antibodies demonstrated a prescribed daily dose to defined daily dose ratio of 1.0, reflecting their appropriate utilization. One hundred twenty-nine patients (37.0%) discontinued their treatment during the study. Patient's level of education (OR: 0.416, 95% CI: 0.183-0.943, p = 0.036), BMI (OR: 2.358, 95% CI: 1.164-4.777, p = 0.017), number of concomitant medications (OR: 2.457, 95% CI: 1.202-5.025, p = 0.014), and treatment duration (OR: 9.180, 95% CI: 4.909-17.165, p < 0.001) were identified as predictors of discontinuation of monoclonal antibodies. Conclusion This study represents the first comprehensive investigation in the United Arab Emirates focused on treatment patterns, utilization, and discontinuation of monoclonal antibodies among the local population. Monoclonal antibodies were prescribed for the management of a wide range of clinical conditions. The study reports appropriate utilization of most monoclonal antibodies and identifies factors such as patient education level, BMI, concomitant medications, and treatment duration as independent predictors of monoclonal antibody treatment discontinuation.
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Affiliation(s)
- Muzoon Matar Saleh Alkaabi
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Syed Arman Rabbani
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Padma GM Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, MAHE, Manipal, Karnataka, India
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Kenny C, Chavrimootoo S, Priyadarshini A. Cost of treating rheumatoid arthritis in the primary care public health system in Ireland: A time-driven activity-based cost analysis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100439. [PMID: 38655193 PMCID: PMC11035073 DOI: 10.1016/j.rcsop.2024.100439] [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: 01/30/2023] [Revised: 03/11/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Background Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining the costs associated with care pathways is a critical part of assessing this value in order to better understand and introduce potential cost-saving interventions. Objectives Examining one such chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary care within the Health Service Executive (HSE) in Ireland. Methods Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member (N = 21) of the primary care RA pathway. Time-Driven Activity-Based Costing (TDABC) was then used to calculate the overall cost of each patient (vignette) type. Results RA is an expensive condition regardless of disease stage. However, newly diagnosed patients as well as those with advanced disease in need of surgical interventions demonstrated the highest costs in terms of primary care personnel use. Additionally, patients prescribed Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more than those on Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) regardless of disease stage or personnel resource use. Conclusion RA and a subset of RA patients that exert the highest healthcare costs are growing in prevalence. Therefore, this study contributes by assessing the costs associated with RA in HSE primary care that can facilitate better understanding the current value being provided and improve upon the current care pathway to cut future costs.
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Affiliation(s)
- Christina Kenny
- College of Business, Technological University Dublin, Aungier Street, Dublin 2, Ireland
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Abbasi-Perez A, Alvarez-Mon MA, Donat-Vargas C, Ortega MA, Monserrat J, Perez-Gomez A, Alvarez-Mon M. Using Twitter Data Analysis to Understand the Perceptions, Beliefs, and Attitudes about Pharmacotherapy Used in Rheumatology: An Observational Study. Healthcare (Basel) 2023; 11:1526. [PMID: 37297665 PMCID: PMC10252953 DOI: 10.3390/healthcare11111526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Twitter has become an important platform for disseminating information about rheumatology drugs by patients, health professionals, institutions, and other users. The aim of this study was to analyze tweets related to 16 drugs used in rheumatology, including their volume, content, and type of user (patients, patients' relatives, health professionals, health institutions, pharmaceutical industry, general press, scientific journals and patients' associations), and to detect inappropriate medical content. A total of 8829 original tweets were obtained, with a random sample of 25% of the total number of tweets for each drug (at least 100 tweets) analyzed. Methotrexate (MTX) accounted for a quarter of all tweets, and there were significant differences in the proportion of tweets issued according to the type of user. Patients and their relatives mainly tweeted about MTX, while professionals, institutions, and patient associations posted more about TNF inhibitors. In contrast, the pharmaceutical industry focused on IL-17 inhibitors. Medical content prevailed in all drugs except anti-CD20 and IL-1 inhibitors and the most discussed medical topic was efficacy, followed by posology and adverse effects. Inappropriate or fake content was found to be very low. In conclusion, the majority of the tweets were about MTX, which is a first-line treatment for several diseases. The distribution of medical content varied according to the type of user. In contrast to other studies, the amount of medically inappropriate content was very low.
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Affiliation(s)
- Adrian Abbasi-Perez
- Service of Internal Medicine, Rheumatology and Autoimmune Diseases, University Hospital “Príncipe de Asturias”, 28805 Alcala de Henares, Spain; (A.A.-P.); (A.P.-G.); (M.A.-M.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
| | - Carolina Donat-Vargas
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, 17177 Stockholm, Sweden;
- IMDEA-Food Institute, Campus of International Excellence, Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, 28049 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
| | - Ana Perez-Gomez
- Service of Internal Medicine, Rheumatology and Autoimmune Diseases, University Hospital “Príncipe de Asturias”, 28805 Alcala de Henares, Spain; (A.A.-P.); (A.P.-G.); (M.A.-M.)
| | - Melchor Alvarez-Mon
- Service of Internal Medicine, Rheumatology and Autoimmune Diseases, University Hospital “Príncipe de Asturias”, 28805 Alcala de Henares, Spain; (A.A.-P.); (A.P.-G.); (M.A.-M.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28805 Alcala de Henares, Spain; (M.A.O.); (J.M.)
- Institute Ramon y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain
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Shyam S, Yadav V, Jaiswal S. Prescription analysis of rheumatology and endocrinology departments of a teaching hospital in Western India. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Mease PJ, Stryker S, Liu M, Salim B, Rebello S, Gharaibeh M, Collier DH. Treatment patterns in rheumatoid arthritis patients newly initiated on biologic and conventional synthetic disease-modifying antirheumatic drug therapy and enrolled in a North American clinical registry. Arthritis Res Ther 2021; 23:236. [PMID: 34496952 PMCID: PMC8424897 DOI: 10.1186/s13075-021-02599-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Background Understanding the evolving treatment patterns in patients with rheumatoid arthritis (RA) is important for rheumatologists to make the best practice decisions and optimize treatment. Here, we describe treatment patterns among patients newly initiated on biologic and/or nonbiologic RA therapy over time after enrollment in the US Corrona RA registry. Methods This was a retrospective, cohort study of adult patients with RA enrolled in the Corrona RA registry. Patients were included in this study if they initiated therapy with conventional synthetic disease-modifying antirheumatic drug (csDMARD) monotherapy, TNF inhibitor (TNFi) monotherapy, other (non-TNFi) biologic monotherapy, or combination therapy (index therapy); initiated therapy between January 1, 2004, and December 31, 2015 (index date), after enrollment in the Corrona RA registry; had at least 6 months of follow-up time after the index date; and had at least one follow-up visit. Time periods of interest were based on the year of index therapy initiation: 2004–2007, 2008–2011, and 2012–2015. Results This study included 8027 patients. csDMARD monotherapy and TNFi + csDMARD combination therapy were the most common index therapies in the registry (39.9% and 44.9%, respectively, in the 2004–2007 period; 38.6% and 38.2%, respectively, in the 2008–2011 period; and 35.2% for both in the 2012–2015 period). At therapy initiation, a higher proportion of patients who initiated other biologics, whether as monotherapies (54.0%) or in combination with csDMARD (49.9%), had high disease activity than those who initiated csDMARD monotherapy (28.4%). For 2012–2015 vs 2004–2007 and 2008–2011 periods, persistence on a given therapy appeared to decrease for the TNFi monotherapy cohort (48.2% vs 64.3% and 52.4%) and other biologic monotherapy cohort (52.3% vs 71.4% and 54.5%) over 12 months; switching from one therapy to another was common in the Corrona RA registry. Conclusions Increased switching from one therapy to another and decreased time on a given therapy was observed in the Corrona RA registry in the 2012–2015 period. This observation is most likely due to the increased availability of additional treatment options and/or the change in clinical focus, particularly the emphasis on achievement of treat-to-target goals of remission or low disease activity along with more aggressive treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02599-4.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and the University of Washington, Seattle, WA, 98122, USA.
| | | | - Mei Liu
- Corrona LLC., Waltham, MA, USA
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Otón T, Carmona L, Andreu JL. Patient's experiences of the barriers and facilitators to Methotrexate. Musculoskeletal Care 2021; 20:158-166. [PMID: 34236743 DOI: 10.1002/msc.1577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the barriers and facilitators of adherence to methotrexate (MTX) in people with rheumatic diseases and to explore the experience of shared decision-making. METHODS A qualitative study was carried out. People diagnosed with inflammatory arthritides or systemic autoimmune diseases and who were treated with MTX were invited to participate in focus groups. The discourse was coded and synthesised with a content analysis approach. RESULTS The groups included 12 representative patients (rheumatoid arthritis, spondylarthritis, and systemic lupus erythematosus, taking either oral or subcutaneous MTX). Four main themes were identified: (1) drug-related aspects (package insert, adverse events, administration, and difficulties with treatment); (2) patient-physician relationship; (3) social environment (lack of visibility of rheumatic diseases and the support of patient associations); and (4) medication and medical care practicalities (information, reliable sources, and expanding knowledge in other health areas). CONCLUSIONS Aspects identified might help improve adherence, including quality information, especially on adverse events, the role of the setting, and shared decision-making.
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Affiliation(s)
- Teresa Otón
- InMusc, Instituto de Salud Musculoesquelética, Madrid, Spain
| | - Loreto Carmona
- InMusc, Instituto de Salud Musculoesquelética, Madrid, Spain
| | - Jose Luis Andreu
- Department of Rheumatology, Hospital Universitario Puerta de Hierro- Majadahonda, Madrid, Spain
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