Adherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritis
Adherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritis
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DOI：
10.1111/j.1524-4733.2010.00764.x
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发表时间：
2010-09-01
期刊：
影响因子：
4.5
通讯作者：
Doshi, Jalpa A.
中科院分区：
文献类型：
--
作者：
Li, Pengxiang;Blum, Marissa A.;Doshi, Jalpa A.
目的：本研究探讨了遵守，中止，并切换类风湿关节炎（RA）生物制剂超过1年的时间后，开始在医疗补助的RA患者的生物治疗。方法：研究样本包括在加州，佛罗里达和纽约的RA医疗补助患者谁新启动依那西普（n = 1359），阿那白滞素（n = 267），或英夫利昔单抗（n = 1012）之间，2000年1月1日至2002年12月31日。在首次使用生物制剂后的12个月内，测量依从性（覆盖天数比例（PDC）>= 0.80）、停药（90天连续间隔）和转换（在停用指示生物制剂后90天内开始使用第二种生物制剂）。通过改变阈值进行敏感性分析，以定义这些措施。Logistic回归分析了与RA生物依从性和停药相关的因素。结果：阿那白滞素使用者的平均PDC（0.36）和依从性患者百分比（11%）最低，其次是依那西普使用者（平均PDC：0.57; %依从性：32%）和英夫利西单抗使用者（平均PDC：0.64; %依从性：43%）。所有三组的停药率都很高（依那西普41%，阿那白滞素76%，英夫利昔单抗41%）。很少有停用索引生物制剂的患者改用另一种生物制剂。Logistic回归分析发现，与加州的患者相比，佛罗里达的患者依从性较低，停用其指示生物制剂的几率较高。阿那白滞素使用者比依那西普使用者依从性低，英夫利西单抗使用者依从性高。阿那白滞素用户有更高的几率比依那西普users.Conclusion：这项研究强调了不良的坚持和过早停止没有并发开关的RA生物制剂，应引起关注的临床医生以及支付。
Objective:This study examined adherence, discontinuation, and switching of rheumatoid arthritis (RA) biologics over a 1-year period after initiation of the biologic treatment in Medicaid patients with RA.Methods:The study sample consisted of Medicaid patients with RA in California, Florida and New York who had newly initiated etanercept (n = 1359), anakinra (n = 267), or infliximab (n = 1012) between January 1, 2000 and December 31, 2002. Adherence (proportion of days covered (PDC) >= 0.80), discontinuation (90-day continuous gap), and switching (initiation of second biologic within 90 days of discontinuation date of index biologic) were measured during the 12-month postindex biologic initiation. Sensitivity analyses were conducted by varying the thresholds to define these measures. Logistic regressions examined the factors associated with RA biologic adherence and discontinuation.Results:Anakinra users had the lowest mean PDC (0.36) and percent adherent patients (11%) followed by etanercept users (mean PDC: 0.57; % adherent: 32%) and infliximab users (mean PDC: 0.64; % adherent: 43%). All three groups had high discontinuation rates (41% etanercept, 76% anakinra, and 41% infliximab). Few patients who discontinued the index biologic switched to another biologic. Logistic regressions found that patients in Florida had lower odds of being adherent and higher odds of discontinuing their index biologic than patients in California. Anakinra users had lower odds and infliximab users had higher odds of being adherent than etanercept users. Anakinra users had higher odds of discontinuation than etanercept users.Conclusion:This study highlights the poor adherence to and premature discontinuation without concurrent switching of RA biologics that should raise concern for clinicians as well as payers.