Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset
Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset
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DOI：
10.3899/jrheum.190535
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发表时间：
2020-08-01
影响因子：
3.9
通讯作者：
Littlejohn, Geoff
中科院分区：
文献类型：
--
作者：
Youssef, Peter;Marcal, Bruno;Littlejohn, Geoff
目标。提供真实世界的证据，说明澳大利亚风湿科医生在治疗类风湿性关节炎(RA)时停止生物(B)和靶向合成(Ts)抗风湿药物(DMARD)的原因，并评估(1)一线治疗的原发失败率，(2)停止一线肿瘤坏死因子抑制剂(TNFi)治疗的患者对二线治疗的持久性。这是一项对2010年8月1日至2017年6月30日期间开始日期为b/tsDMARD的澳大利亚风湿病(Opal)数据库中登记的澳大利亚优化患者结局的RA患者进行的多中心回顾性非干预性研究。原发失败定义为在治疗开始后6个月内停止治疗。分析了7740名患者的数据；6914名患者接受了一线b/tsDMARD。3383名(49%)患者停止一线治疗；1263名(37%)患者被归类为原发失败。最常见的原因是“疗效不佳”(947/2656，36%)。在停止一线治疗的患者中，43%(1111/2560)接受了二线治疗，与未接受二线治疗的患者相比，停止二线治疗的中位时间最短(11个月，95%可信区间9~12)。一线治疗后二线中位治疗持续时间最长的是接受利妥昔单抗治疗的患者(39个月，95%可信区间27~74)。尽管有证据表明二线b/tsDMARD具有不同的作用模式，但停止一线TNFi治疗的患者中有很大一部分接受了另一次TNFi治疗。缺乏疗效被记录为改变类风湿关节炎患者一线治疗的最常见原因。
Objective. To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi).Methods. This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation.Results. Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was "lack of efficacy" (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27-74).Conclusion. A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.