Temporal Trends in Use of Biologic DMARDs for Rheumatoid Arthritis in the United States: A Cohort Study of Publicly and Privately Insured Patients
Temporal Trends in Use of Biologic DMARDs for Rheumatoid Arthritis in the United States: A Cohort Study of Publicly and Privately Insured Patients
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DOI：
10.18553/jmcp.2017.23.8.809
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发表时间：
2017-08-01
影响因子：
2.1
通讯作者：
Kim, Seoyoung C.
中科院分区：
文献类型：
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作者：
Desai, Rishi J.;Solomon, Daniel H.;Kim, Seoyoung C.
背景技术背景：十种生物疾病缓解抗风湿药物（bDMARDs）可用于治疗类风湿关节炎（RA），但对这些药物使用的人群水平时间趋势知之甚少。目的：描述美国私人或公共保险RA患者使用bDMARDs的时间趋势。使用了私人（Upturn Clinformatics，2004 - 2015）和公共（Medicaid Analytic eXtract [MAX]，2000 - 2010）保险计划的索赔数据。将RA诊断代码和连续健康计划入组1年基线期和1年随访期的患者分为2个单独队列：（1）未使用任何bDMARD的患者或（2）基线期使用单一bDMARD的患者。在1年随访期间，组1开始第一次bDMARD治疗并从组2转换为第二次bDMARD治疗被确定为关注的结局。使用混合效应回归模型，我们计算了bDMARD的启动和转换的年比率，并对病例组合进行了调整。我们还描述了所有的启动和开关的比例占每个agent.RESULTS：有113,031 RA患者与公共保险和97,751 RA患者与私人保险谁被列入研究。在医疗补助数据中，偶发性RA患者（从1.1到3.1，P = 0.0006）和流行性RA患者（从4.6到10.9，P = 0.008）的bDMARD启动率（每100例患者）随时间显著增加。在Optum Clinformatics数据中，发生率稳定，每100例新发RA患者中有7.7至8.3例（P = 0.10），每100例现患RA患者中有11.0至11.5例（P = 0.12）。在Medicaid数据中，转换率（每100例患者）随时间从6.4增加到16.0（P = 0.04），在Optum Clinformatics数据中从9.1增加到17.0（P = 0.00003）。依那西普作为最常见的一线药物的使用稳定在所有生物制剂起始的约50%，但英夫利西单抗的使用减少，而新药物的使用增加。近年来，越来越多的RA患者使用bDMARD，并且包括certolizumab、golumumab和tocilizuamab在内的新型药物的使用也在增加，这强调了需要进一步比较这些药物的安全性和有效性研究，以更好地指导基于证据的决策。版权所有（C）2017，管理护理药房学院. All rights reserved.
BACKGROUND: Ten biologic disease-modifying antirheumatic drugs (bDMARDs) are available as treatment for rheumatoid arthritis (RA), but relatively little is known about population-level time trends in the use of these agents.OBJECTIVE: To describe time trends in the use of bDMARDs in RA patients with private or public insurance in the United States.METHODS: Claims data from private (Upturn Clinformatics, 2004-2015) and public (Medicaid Analytic eXtract [MAX], 2000-2010) insurance programs were used. Patients with RA diagnosis codes and continuous health plan enrollment for 1-year baseline and 1-year follow-up periods were identified into 2 separate cohorts: (1) patients not using any bDMARD or (2) patients using a single bDMARD during the baseline period. Initiation of the first bDMARD from group 1 and switch to a second bDMARD from group 2 was identified as the outcome of interest during the 1-year follow-up period. Using mixed-effects regression models, we calculated yearly rates of initiation and switch for bDMARDs, adjusted for case-mix. We also described the proportion of all initiations and switches accounted for by each agent.RESULTS: There were 113,031 RA patients with public insurance and 97,751 RA patients with private insurance who were included in the study. The rates of initiation of bDMARDs (per 100 patients) increased significantly over time in Medicaid data for incident RA patients (from 1.1 to 3.1, P=0.0006) and prevalent RA patients (from 4.6 to 10.9, P=0.008). In Optum Clinformatics data, the rates were stable, with 7.7 to 8.3 per 100 incident RA patients (P=0.10) and 11.0 to 11.5 per 100 prevalent RA patients (P=0.12). The rates of switching (per 100 patients) increased over time from 6.4 to 16.0 (P=0.04) in Medicaid data and 9.1 to 17.0 (P=0.00003) in Optum Clinformatics data. Use of etanercept as the most common first-line agent was stable at approximately 50% of all biologic initiations, but use of infliximab decreased and the use of newer agents increased.CONCLUSIONS: More RA patients used bDMARDs in recent years, and use of newer agents, including certolizumab, golumumab, and tocilizuamab, is rising, which highlights a need for further comparative safety and effectiveness research of these agents to better guide evidence-based decision making. Copyright (C) 2017, Academy of Managed Care Pharmacy. All rights reserved.