Etanercept and Adalimumab Treatment Patterns in Psoriatic Arthritis Patients Enrolled in a Commercial Health Plan
Etanercept and Adalimumab Treatment Patterns in Psoriatic Arthritis Patients Enrolled in a Commercial Health Plan
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DOI：
10.1007/s12325-012-0039-3
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发表时间：
2012-08-01
影响因子：
3.8
通讯作者：
Gandra, Shravanthi R.
中科院分区：
文献类型：
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作者：
Chastek, Benjamin;Fox, Kathleen M.;Gandra, Shravanthi R.
对接受肿瘤坏死因子 (TNF) 阻滞剂依那西普或阿达木单抗的银屑病关节炎 (PsA) 患者的治疗模式（包括持续性、治疗间隙、转换和停药）进行了检查。这项回顾性研究利用了美国商业健康计划的管理索赔数据。 2006 年 1 月 1 日至 2008 年 12 月 31 日期间开始使用依那西普或阿达木单抗作为指标治疗的 PsA 成人（年龄 18-64 岁）纳入分析。患者在指数治疗开始前至少 6 个月和开始后至少 12 个月连续参加健康计划。评估初始 TNF 阻滞剂剂量和治疗持续率（连续使用指标药物，间隔至少 60 天）、治疗间隙和停药率（治疗间隔至少 60 天）。停止治疗的患者进一步分类为：(1) 停止所有生物治疗，(2) 重新开始指标药物治疗，(3) 改用另一种生物治疗，或 (4) 其他。共有 346 名 PsA 患者（202 例依那西普，144 例阿达木单抗）符合资格。大多数（90.6% 依那西普；88.9% 阿达木单抗）以标签剂量开始指数治疗。 50% 的依那西普患者和 45% 的阿达木单抗患者坚持指数治疗 12 个月（P = 0.37）。与使用阿达木单抗的患者相比，使用依那西普的患者的持续时间较长（434 天 vs. 353 天；P = 0.02），至少 7 天的停顿次数较多（4.7 天 vs. 3.5；P = 0.004），平均停顿时间较长（48.6 天 vs. 29.3 天；P = 0.01）。在停药的患者中（24.8% 依那西普；35.1% 阿达木单抗），分别有 46.4% 和 41.5% 重新开始使用依那西普和阿达木单抗； 24.8% 和 35.1% 停用所有 TNF 阻滞剂； 20.0% 和 19.2% 转用另一种生物制剂； 8.8% 和 4.3% 的患者进行了其他治疗改变。大约一半的 PsA 患者持续使用其指标 TNF 阻滞剂 12 个月。治疗暂停和治疗中断很常见，但超过 40% 的患者在中断后重新开始使用指数 TNF 阻滞剂。
Treatment patterns, including persistence, gaps in therapy, switching, and discontinuation, were examined in patients with psoriatic arthritis (PsA) who received the tumor necrosis factor (TNF)-blockers etanercept or adalimumab.This retrospective study utilized administrative claims data from a United States commercial health plan. Adults (age 18-64 years) with PsA who started therapy with etanercept or adalimumab as index therapy between January 1, 2006 and December 31, 2008 were included in the analysis. Patients were continuously enrolled in the health plan for at least 6 months before and at least 12 months after the start of index therapy. Initial TNF-blocker dose and rates of therapy persistence (continuous use of index medication without a gap of at least 60 days), therapy gaps, and discontinuation (gap in therapy of at least 60 days) were estimated. Those who discontinued were further classified as: (1) discontinued all biologic therapy, (2) restarted index medication, (3) switched to another biologic therapy, or (4) other.A total of 346 patients with PsA (202 etanercept, 144 adalimumab) were eligible. Most (90.6% etanercept; 88.9% adalimumab) started index therapy at the labeled dose. Persistence with index therapy for 12 months was observed in 50% of patients on etanercept and 45% of patients on adalimumab (P = 0.37). Patients on etanercept had a longer duration of persistence (434 vs. 353 days; P = 0.02), more pauses of at least 7 days (4.7 vs. 3.5; P = 0.004), and a longer mean pause length (48.6 vs. 29.3 days; P = 0.01) than patients on adalimumab. Of patients who discontinued (24.8% etanercept; 35.1% adalimumab), 46.4% and 41.5% restarted etanercept and adalimumab, respectively; 24.8% and 35.1% discontinued all TNF-blockers; 20.0% and 19.2% switched to another biologic; and 8.8% and 4.3% had other therapy changes.Approximately half of PsA patients were persistent on their index TNF-blocker for 12 months. Pauses in therapy and therapy discontinuation were common, but more than 40% of patients restarted their index TNF-blocker after discontinuation.