Factors associated with initial or subsequent choice of biologic disease-modifying antirheumatic drugs for treatment of rheumatoid arthritis
Factors associated with initial or subsequent choice of biologic disease-modifying antirheumatic drugs for treatment of rheumatoid arthritis
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DOI：
10.1186/s13075-017-1366-1
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发表时间：
2017-07-05
影响因子：
4.9
通讯作者：
Kim, Seoyoung C.
中科院分区：
文献类型：
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作者：
Jin, Yinzhu;Desai, Rishi J.;Kim, Seoyoung C.
背景：抗风湿药物(DMARD)越来越多地用于类风湿性关节炎(RA)的治疗。然而，基于当代数据，关于DMARD的相关因素以及在最初和随后的RA治疗中使用生物DMARD的模式，我们知之甚少。方法：我们使用来自商业健康计划(2004-2013)和医疗补助(2000-2010)的索赔数据进行了一项观察性队列研究：早期未治疗的RA患者对任何类型的DMARD都很天真，以及流行的RA患者以前或以前接触过一种生物DMARD。结果：共发现195,433例RA患者，其中早期未经治疗的RA患者78,667例(40%)，早期未治疗的RA患者93,534例(48%)，曾接受过生物DMARD治疗的RA患者23,232例(12%)。商业保险的患者发起生物DMARD的可能性比医疗补助的患者高87%(OR=1.87，95%CI=1.70-2.05)。在医疗补助计划中，非裔美国人启动(早期未治疗RA的OR=0.59，95%CI=0.51~0.68；流行RA的OR=0.71，95%CI=0.61~0.74)和转换(OR=0.71，95%CI=0.55~0.90)生物DMARDS的几率低于非西班牙裔白人。既往使用类固醇和非生物DMARD预示着生物性DMARD的启动和随后的转换。依那西普、阿达利单抗和英夫利昔单抗是最常用的一线和二线生物DMARDS；使用anakinra和Golimumab的患者最有可能改用其他生物DMARDS。结论：保险类型、种族和既往使用类固醇和非生物DMARDS与首次或随后的生物DMARDS治疗密切相关。
Background: Biologic disease-modifying antirheumatic drugs (DMARDs) are increasingly used for rheumatoid arthritis (RA) treatment. However, little is known based on contemporary data about the factors associated with DMARDs and patterns of use of biologic DMARDs for initial and subsequent RA treatment.Methods: We conducted an observational cohort study using claims data from a commercial health plan (2004-2013) and Medicaid (2000-2010) in three study groups: patients with early untreated RA who were naive to any type of DMARD and patients with prevalent RA with or without prior exposure to one biologic DMARD. Multivariable logistic regression models were used to examine the effect of patient demographics, clinical characteristics and healthcare utilization factors on the initial and subsequent choice of biologic DMARDs for RA.Results: We identified a total of 195,433 RA patients including 78,667 (40%) with early untreated RA and 93,534 (48%) and 23,232 (12%) with prevalent RA, without or with prior biologic DMARD treatment, respectively. Patients in the commercial insurance were 87% more likely to initiate a biologic DMARD versus patients in Medicaid (OR = 1.87, 95% CI = 1.70-2.05). In Medicaid, African-Americans had lower odds of initiating (OR = 0.59, 95% CI = 0.51-0.68 in early untreated RA; OR = 0.71, 95% CI = 0.61-0.74 in prevalent RA) and switching (OR = 0.71, 95% CI = 0.55-0.90) biologic DMARDs than non-Hispanic whites. Prior use of steroid and non-biologic DMARDs predicted both biologic DMARD initiation and subsequent switching. Etanercept, adalimumab, and infliximab were the most commonly used first-line and second-line biologic DMARDS; patients on anakinra and golimumab were most likely to be switched to other biologic DMARDS.Conclusions: Insurance type, race, and previous use of steroids and non-biologic DMARDs were strongly associated with initial or subsequent treatment with biologic DMARDs.