Drug survival and reasons for discontinuation of the first biological disease modifying antirheumatic drugs in Thai patients with rheumatoid arthritis: Analysis from the Thai Rheumatic Disease Prior Authorization registry
Drug survival and reasons for discontinuation of the first biological disease modifying antirheumatic drugs in Thai patients with rheumatoid arthritis: Analysis from the Thai Rheumatic Disease Prior Authorization registry
复制标题
DOI：
10.1111/1756-185x.12937
复制
发表时间：
2018-01-01
影响因子：
2.5
通讯作者：
Katchamart, Wanruchada
中科院分区：
文献类型：
--
作者：
Narongroeknawin, Pongthorn;Chevaisrakul, Parawee;Katchamart, Wanruchada
目的评价和比较类风湿性关节炎（RA）患者生物疾病修饰抗风湿药物（bDMARDs）在现实生活中的保留率，并确定与缓解和停药相关的危险因素。方法从2009年12月至2014年10月风湿病预先授权注册中心中选取256例符合RA标准并开始bDMARD治疗的患者。记录基线人口统计学和临床数据。分析了5年随访期间bDMARD停药的累积概率以及与RA缓解和bDMARD停药相关的因素。结果近一半（46%）的患者最初使用利妥昔单抗（RTX）， 33%的患者使用依那西普（ETN）， 21%的患者使用英夫利昔单抗（IFX）。不到10%的人随后切换到第二个bDMARD。持续首次bDMARD治疗的患者的1年和5年缓解率分别为7.2%和21.5%。5年时，RTX、ETN和IFX的药物生存率分别为50%、25%和22%。多因素分析显示，RTX与最高药物生存率显著相关。相对于RTX， IFX和ETN停药的风险比分别为2.60（95%可信区间[CI] 1.53-4.42）和2.15 （95% CI 1.36-3.42）。39%的患者因反应不足（42%）、严重不良事件（22%）、不依从（14%）或缓解/疾病活动性低（13%）而停止治疗。结论：在5年多的时间里，只有三分之一的患者继续使用他们的第一次bDMARD。停药的主要原因是反应不足。
AimTo evaluate and compare the retention rate of biological disease-modifying antirheumatic drugs (bDMARDs) in real-life practice and identify risk factors related to remission and drug discontinuation in patients with rheumatoid arthritis (RA).MethodA total of 256 patients fulfilling criteria for RA and starting bDMARD between December 2009 and October 2014 were selected from the Rheumatic Disease Prior Authorization registry. Baseline demographic and clinical data were recorded. The cumulative probability of bDMARD discontinuation over 5 years of follow-up and factors associated with RA remission and bDMARD withdrawal were analyzed.ResultsAlmost half (46%) of patients were initially treated with rituximab (RTX), with 33% treated with etanercept (ETN) and 21% with infliximab (IFX). Fewer than 10% were subsequently switched to a second bDMARD. The 1- and 5-year remission rates in patients continuing their first bDMARD were 7.2% and 21.5%, respectively. At 5 years, the drug survival rates for RTX, ETN and IFX were 50%, 25% and 22%, respectively. Multivariate analysis showed that RTX was significantly associated with highest drug survival. Relative to RTX, the hazard ratios for discontinuation of IFX and ETN were 2.60 (95% confidence interval [CI] 1.53-4.42) and 2.15 (95% CI 1.36-3.42), respectively. Thirty-nine percent of patients stopped treatments, due to inadequate response (42%), serious adverse events (22%), nonadherence (14%) or remission/low disease activity (13%).ConclusionOver 5 years, only one-third of patients continued using their first bDMARD. The leading cause of drug discontinuation was inadequate response.