Outcomes of tumor necrosis factor inhibitor cycling versus switching to a disease-modifying anti-rheumatic drug with a new mechanism of action among patients with rheumatoid arthritis
Outcomes of tumor necrosis factor inhibitor cycling versus switching to a disease-modifying anti-rheumatic drug with a new mechanism of action among patients with rheumatoid arthritis
复制标题
DOI：
10.1080/13696998.2016.1275653
复制
发表时间：
2017-05-01
影响因子：
2.4
通讯作者：
Curtis, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Chastek, Benjamin;Becker, Laura K.;Curtis, Jeffrey R.
目的：研究类风湿关节炎患者从肿瘤坏死因子抑制剂（TNFi）（阿达木单抗、certolizumab pegol、依那西普、golimumab或英夫利昔单抗）切换到另一种TNFi（“TNFi循环者”）或切换到新的作用机制（阿巴接受、托珠单抗或托法替尼）（“新的MOA切换者”）后1年的治疗模式、治疗效果和治疗成本。方法：本回顾性队列研究使用了一家国家保险公司的行政索赔数据。对转换后12个月的治疗持续性（没有再次转换、重新开始或停止）、治疗有效性（定义见下文）和成本进行评估。如果患者满足治疗有效性算法的所有六个标准（高依从性，无剂量增加，无新的常规合成疾病改善抗风湿药物，无后续治疗切换，无新的/增加口服糖皮质激素，以及< 2次糖皮质激素注射），则患者得到有效治疗。采用多变量logistic模型对基线因素进行调整。结果：数据库中新增MOA切换者581人，TNFi循环者935人。新的MOA转换者比TNFi循环者在转换后坚持治疗的可能性高39%（优势比[OR]=1.39； 95%可信区间[CI]=1.12-1.74; p= 0.003），再次转换治疗的可能性低36% (OR=0.64; 95% CI=0.51-0.81; p
Objectives: To examine treatment patterns, treatment effectiveness, and treatment costs for 1 year after patients with rheumatoid arthritis switched from a tumor necrosis factor inhibitor (TNFi) (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab), either cycling to another TNFi ("TNFi cyclers") or switching to a new mechanism of action (abatacept, tocilizumab, or tofacitinib) ("new MOA switchers").Methods: This retrospective cohort study used administrative claims data for a national insurer. Treatment persistence (without switching again, restarting, or discontinuing), treatment effectiveness (defined below), and costs were assessed for the 12-month post-switch period. Patients were effectively treated if they satisfied all six criteria for a treatment effectiveness algorithm (high adherence, no dose increase, no new conventional synthetic disease-modifying anti-rheumatic drug, no subsequent switch in therapy, no new/increased oral glucocorticoids, and < 2 glucocorticoid injections). Multivariable logistic models were used to adjust for baseline factors.Results: The database included 581 new MOA switchers and 935 TNFi cyclers. New MOA switchers were 39% more likely than TNFi cyclers to persist after the switch (odds ratio [OR]=1.39; 95% confidence interval [CI]=1.12-1.74; p=.003) and 36% less likely to switch therapy again (OR=0.64; 95% CI=0.51-0.81; p