Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice.
Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice.
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DOI：
10.1002/acr.20629
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发表时间：
2011-12
影响因子：
4.7
通讯作者：
Sauer BC
中科院分区：
文献类型：
--
作者：
Cannon GW;Mikuls TR;Hayden CL;Ying J;Curtis JR;Reimold AM;Caplan L;Kerr GS;Richards JS;Johnson DS;Sauer BC
将退伍军人事务部风湿性关节炎（VARA）登记处和VA药房福利管理（PBM）数据库连接起来，以确定甲氨蝶呤（MTX）依从性与RA疾病活动性的相关性。对于每例患者，计算新的和已确定的MTX使用者首次MTX暴露≥12周的药物拥有率（MPR）。高MTX依从性定义为MPR ≥0.80和低MTX依从性<0.80。对于每例患者，在高依从性组与低依从性组中比较登记随访期间观察到的平均DAS 28、ESR和CRP。在455例RA患者中，与低依从性患者（n=85）相比，高依从性患者（n=370）的MTX处方剂量（16± 4 mg vs 16± 4 mg，p=0.6）相似。然而，高依从性组患者实际观察到的MTX剂量显著更高（16±5mg vs 11±3mg，p<0.001）。高依从性组的DAS 28（3.6±1.2 vs 3.9±1.5，p<0.02）、ESR（24±18 vs 29±24，p= 0.05）和CRP（1.2±1.3 vs 1.6±1.5，p<0.03）低于低MTX依从性组。这些差异不能用基线人口统计学特征、同期治疗或MTX是否在VARA入组之前或之后开始的差异来解释。高MTX依从性与MTX治疗RA患者的临床结局改善相关。潜在混杂因素的调整并没有改变依从性的估计效果。这些结果表明，能够合并临床观察与药房数据库，以评估抗风湿药物在临床实践中的优势。
The Veterans Affairs Rheumatoid Arthritis (VARA) registry and the VA Pharmacy Benefits Management (PBM) database were linked to determine the association of methotrexate (MTX) adherence with RA disease activity. For each patient, the medication possession ratio (MPR) was calculated for the first episode of MTX exposure of ≥12 weeks duration for both new and established MTX users. High MTX adherence was defined as an MPR ≥0.80 and low MTX adherence <0.80. For each patient, the mean DAS28, ESR, and CRP observed during registry follow-up were compared in high versus low adherence groups. In 455 RA patients, the prescribed doses of MTX (16±4mg versus 16±4mg, p=0.6) were similar in high adherence patients (n=370) in comparison to low adherence patients (n=85). However, the actual observed MTX doses taken by patients were significantly higher in the high adherence group (16±5mg versus 11±3mg, p<0.001). DAS28 (3.6±1.2 versus 3.9±1.5, p<0.02), ESR (24±18 versus 29±24, p= 0.05) and CRP (1.2±1.3 versus 1.6±1.5, p<0.03) were lower in the high adherence group compared to those with low MTX adherence. These variances were not explained by differences in baseline demographic features, concurrent treatments, or whether MTX was initiated before or after VARA enrollment. High MTX adherence was associated with improved clinical outcomes in RA patients treated with MTX. Adjustment for potential confounders did not alter the estimated effect of adherence. These results demonstrate the advantages of being able to merge clinical observations with pharmacy databases to evaluate anti-rheumatic drugs in clinical practice.