Adherence to disease-modifying antirheumatic drugs and the effects of exposure misclassification on the risk of hospital admission.
Adherence to disease-modifying antirheumatic drugs and the effects of exposure misclassification on the risk of hospital admission.
复制标题
坚持使用缓解疾病的抗风湿药物以及暴露错误分类对入院风险的影响。
DOI：
10.1002/acr.20087
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发表时间：
2010
影响因子：
4.7
通讯作者：
Griffin,MarieR
中科院分区：
文献类型：
--
作者：
Grijalva,CarlosG;Kaltenbach,Lisa;Arbogast,PatrickG;MitchelJr,EdwardF;Griffin,MarieR
目的描述不同的抗风湿药物暴露分类策略对药物-结果关联的影响。方法我们研究了1995-2005年间类风湿关节炎(RA)患者DMARD启动与全因住院的关系。对DMARDS和口服糖皮质激素的起始剂进行了180d的≤追踪。我们比较了两种暴露分类方法：持续暴露要求(PER)方法和持续暴露忽略(PEI)方法，其中持续暴露要求(PER)方法在方案改变时停止跟踪；持续暴露忽略(PEI)方法在方案改变的情况下继续跟踪。对于PEI，使用药物拥有率来评估依从性。以COX模型和甲氨蝶呤为参照物，比较RA方案发起者的全因住院风险。在PER分析中，与甲氨蝶呤相比，肿瘤坏死因子α拮抗剂没有增加住院风险，而来氟米特则增加了住院风险(危险比[HR]1.36，95%可信区间[95%CI]1.1-1.67)。糖皮质激素增加住院风险(低、中、高剂量分别为1.29、1.54和2.03)。PEI的结果与PER相似，只是英夫利昔单抗与甲氨蝶呤相比增加了住院风险(HR 1.46，95%CI 1.19-1.8)，而大多数其他效应更接近于零。在PEI中，依那西普的依从性为73%，糖皮质激素的依从性为6%，对甲氨蝶呤的依从性为59%。结论与甲氨蝶呤启动组相比，来氟米特或糖皮质激素启动组在前180天持续增加各种原因的住院率。大多数PER和PEI估计是相似的；观察到这些方法之间的风险差异可能是由于依从性的差异。
ObjectiveTo describe the effect of different exposure classification strategies for disease‐modifying antirheumatic drugs (DMARDs) on drug‐outcome associations.MethodsWe studied the association between DMARD initiation and all‐cause hospitalizations in patients with rheumatoid arthritis (RA), 1995–2005. Initiators of DMARDs and oral glucocorticoids were followed for ≤180 days. We compared 2 strategies for exposure classification: a persistent exposure required (PER) approach, in which followup stopped when the regimen changed; and a persistent exposure ignored (PEI) approach, in which followup continued despite regimen changes. For PEI, adherence was assessed using the medication possession ratio. All‐cause hospitalization risk was compared among RA regimen initiators using Cox models and methotrexate as the reference.ResultsWe identified 28,906 episodes of medication initiation. In PER analyses, tumor necrosis factor α antagonists did not increase hospitalization risk compared with methotrexate, whereas leflunomide did (hazard ratio [HR] 1.36, 95% confidence interval [95% CI] 1.1–1.67). Glucocorticoids increased hospitalization risk (HR 1.29, 1.54, and 2.03 for low, medium, and high doses, respectively). PEI results were similar to PER except that infliximab initiation increased the risk of hospitalization compared with methotrexate (HR 1.46, 95% CI 1.19–1.8), and most other effects were closer to the null. In PEI, adherence ranged from 73% for etanercept to 6% for glucocorticoids and adherence to methotrexate was 59%.ConclusionCompared with methotrexate initiation, leflunomide or glucocorticoid initiation consistently increased all‐cause hospitalizations in the first 180 days of use. Most PER and PEI estimates were similar; observed differences in risk between these methods were likely due to differences in adherence.