Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions.
Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions.
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DOI：
10.1002/art.39521
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Kim SC
中科院分区：
文献类型：
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作者：
Desai RJ;Huybrechts KF;Bateman BT;Hernandez-Diaz S;Mogun H;Gopalakrishnan C;Patorno E;Kim SC
描述系统性红斑狼疮（SLE）、类风湿性关节炎（RA）、银屑病关节炎（PsA）或强直性脊柱炎（AS）孕妇使用免疫调节剂的模式和长期趋势。确定了一组参加公共（Medicaid，2001-2010）或私人（OptumClinformatics，2004-2012）健康保险的SLE、RA、PsA或AS女性，并纳入了在妊娠前3个月内填写免疫调节剂处方（包括类固醇、非生物疾病缓解剂和生物制剂）的女性。报告了妊娠期间继续使用或停用单个药物的女性比例。在考虑患者特征和混合效应回归模型中逐年随机变异性后估计的年度处方填充率用于进行时间趋势分析。共纳入了2，645名在妊娠前积极接受免疫调节剂治疗的女性。PsA或AS患者在妊娠期停止服用免疫调节剂的比例（61%）高于SLE（26%）或RA（34.5%）。从孕早期到孕晚期，在所有适应症中，服用免疫调节剂处方的女性比例都有所下降。总体而言，类固醇（48.4%）和羟氯喹（27.1%）是妊娠期最常用的药物。怀孕期间类固醇处方填充率（我们队列中每100例分娩报告）从54.4显著下降到42.4;而生物制剂的比率从2001年至2012年期间的5.1增加到16.6（两种趋势均为p<0.001）。类固醇和羟氯喹仍然是妊娠期最广泛的处方治疗选择;但生物制剂的使用正变得越来越普遍。
To describe patterns and secular trends in use of immunomodulatory agents in pregnant women with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS). A cohort of women with SLE, RA, PsA, or AS enrolled in public (Medicaid, 2001–2010) or private (OptumClinformatics, 2004–2012) health insurance was identified and women filling prescriptions for immunomodulatory agents- including steroids, non-biologic disease-modifying agents, and biologics- in the 3-month period immediately prior to their pregnancy were included. The proportion of women continuing or discontinuing individual agents during pregnancy was reported. Annual prescription fill rates, estimated after accounting for patient characteristics and random variability from year-to-year in mixed-effect regression models, were used to conduct time-trends analysis. A total of 2,645 women actively treated with immunomodulatory agents prior to pregnancy were included. More women with PsA or AS stopped filling immunomodulatory prescriptions in pregnancy (61%) than those with SLE (26%) or RA (34.5%). From the first to the third trimester, the proportion of women filling prescriptions for immunomodulatory agents decreased across all indications. Overall, steroids (48.4%) and hydroxychloroquine (27.1%) were the most frequently used agents in pregnancy. The rates (reported per 100 deliveries in our cohort) for steroid prescription fills during pregnancy fell significantly from 54.4 to 42.4; while rates for biologics increased from 5.1 to 16.6 between 2001 and 2012 (p<0.001 for both trends). Steroids and hydroxychloroquine remain the most widely prescribed treatment options in pregnancy; but the use of biologics is becoming increasingly common.