Injectable tumor necrosis factor α inhibitors and outpatient antimicrobial use in children with rheumatic diseases: analyses of prescription claims from a pharmacy benefit manager database.
Injectable tumor necrosis factor α inhibitors and outpatient antimicrobial use in children with rheumatic diseases: analyses of prescription claims from a pharmacy benefit manager database.
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风湿病儿童注射型肿瘤坏死因子α抑制剂和门诊抗菌药物的使用：对药房福利管理数据库中处方索赔的分析。
DOI：
10.1002/acr.22053
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发表时间：
2013
影响因子：
4.7
通讯作者：
Sullivan,SeanD
中科院分区：
文献类型：
--
作者：
Ringold,Sarah;Grant,Shannon;Girdish,Charmaine;Wallace,CarolA;Sullivan,SeanD
目的评估接受甲氨蝶呤和/或注射肿瘤坏死因子α (iTNFα)抑制剂（依那西普和/或阿达木单抗）的儿童门诊抗生素和抗病毒药物使用的发生率和比率，并将这些比率与对照人群进行比较。方法从药品福利管理（PBM）数据库获取数据。如果儿童在2008年至2010年间有儿科或成人风湿病学家开具的iTNFα抑制剂或甲氨蝶呤处方索赔≥1份，并且在索赔时年龄<18岁，则纳入该研究。从PBM数据库中随机选择儿童作为对照队列。采用泊松回归比较抗菌率比（rr）。发病率和rrr根据年龄、性别和泼尼松暴露进行调整。结果共纳入患儿4312例。与对照组相比，接受甲氨蝶呤单药治疗或iTNFα抑制剂和甲氨蝶呤联合治疗的儿童抗生素处方调整后的相对危险度分别为2.18（95%可信区间[95% CI] 1.92-2.47）和2.12 （95% CI 1.79-2.50）。与对照组相比，接受甲氨蝶呤单药治疗或iTNFα抑制剂和甲氨蝶呤联合治疗的儿童抗病毒处方的调整后相对危险度分别为3.67 （95% CI 1.98-6.78）和4.34 （95% CI 1.86-10.14）。iTNFα抑制剂组的RRs在大小上相似。抗生素或抗病毒处方的药物暴露类别之间的rr没有显著差异。结论与对照组相比，接受甲氨蝶呤和/或iTNFα抑制剂治疗的儿童使用抗生素和抗病毒药物的比例更高。需要额外的患者水平和疾病特异性数据集来更详细地评估这种关联。
ObjectiveTo estimate the incidence and rate of outpatient antibiotic and antiviral medication use among children receiving methotrexate and/or an injectable tumor necrosis factor α (iTNFα) inhibitor (etanercept and/or adalimumab) and to compare these rates with those of a control population.MethodsData were obtained from a pharmacy benefit manager (PBM) database. Children were included if they had ≥1 prescription claim for an iTNFα inhibitor or methotrexate prescribed by a pediatric or adult rheumatologist between 2008 and 2010 and if they were age <18 years at the time of the claim. A control cohort of randomly selected children was generated from the PBM database. Poisson regression was used to compare antimicrobial rate ratios (RRs). Incidence rates and RRs were adjusted for age, sex, and prednisone exposure.ResultsIn total, 4,312 children were included. The adjusted RRs for antibiotic prescriptions among children receiving methotrexate monotherapy or iTNFα inhibitor and methotrexate combination therapy compared with the control cohort were 2.18 (95% confidence interval [95% CI] 1.92–2.47) and 2.12 (95% CI 1.79–2.50), respectively. The adjusted RRs for antiviral prescriptions among children receiving methotrexate monotherapy or iTNFα inhibitor and methotrexate combination therapy compared with the control cohort were 3.67 (95% CI 1.98–6.78) and 4.34 (95% CI 1.86–10.14), respectively. The RRs for the iTNFα inhibitor group were similar in magnitude. There was no significant difference in RRs between the medication exposure categories for either antibiotic or antiviral prescriptions.ConclusionChildren receiving methotrexate and/or an iTNFα inhibitor had higher rates of antibiotic and antiviral use compared with the control cohort. Data sets with additional patient‐level and disease‐specific data are required to assess this association in more detail.