類風濕關節炎患者bDMARDs治療的依從性分析

類風濕關節炎患者bDMARDs治療的依從性分析: 依那西普依從性優於阿達木單抗及英夫利昔單抗

類風濕關節炎患者bDMARDs治療的

依從性分析: 依那西普依從性優於

阿達木單抗及英夫利昔單抗

目 標

本研究對阿達木單抗、依那西普、英夫利昔單抗或阿巴西普作為類風濕關節炎一線和二線及以上治療方法在韓國臨床實踐中的依從性進行研究和比較。

方 法

本研究利用全國性的韓國國家健康保險資料庫，對在2009年7月1日至2012年12月31日期間接受阿達木單抗、依那西普、英夫利昔單抗或阿巴西普治療的患者進行回顧性隊列研究。將首次進行生物治療的患者和此前接受過其他生物治療的患者分為首次使用和再次使用兩個隊列。在治療開始後的1年內對治療模式的依從性進行測量，而中斷包含重新開始治療、更換治療方法和停止治療三種情況。利用Cox比例風險模型來估計生物療法中斷的危險比（HR）及其95%的置信區間(CI)。

結 果

首次使用隊列有4114名患者，再次使用隊列有992名患者。經觀察，首次使用隊列中，持續使用阿達木單抗、依那西普和英夫利昔單抗進行治療的患者比例分別為52.5%、56.1%和52.6%，根據Cox比例危險模型，各療法持續時間上不存在明顯差異。再次使用隊列中，持續使用3種TNFi的患者比例分別為45.7%、58.5%、43.0%和60.4%。通過Cox比例危險模型計算髮現，使用依那西普(HR = 0.68, 95% CI: 0.52–0.88)和阿巴西普(HR = 0.53; 95% CI: 0.37–0.74)的患者與使用英夫利昔單抗的患者相比，後者更有可能中斷治療。

結 論

3種TNFi作為一線治療時，在一年內的依從性相似。然而，當作為二線及以上治療方法時，依那西普和阿巴西普的依從性優於英夫利昔單抗或阿達木單抗。在為韓國的類風濕關節炎患者選擇二線及以上生物治療方法時，依從性作為其中一項考慮因素。

原 文

Persistence of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: An analysis of the South Korean National Health Insurance Database

Objectives

This study examined and compared the persistence of adalimumab, etanercept, infliximab, or abatacept as first- and subsequent-line treatment for rheumatoid arthritis in the South Korean clinical practice.

Methods

We conducted a retrospective cohort study with patients receiving adalimumab, etanercept, infliximab, or abatacept between July 1, 2009 and December 31, 2012, using the nationwide Korean National Health Insurance database. Patients who were receiving a newly initiated biologic treatment and those who switched from other biologic treatment were identified and classified into first- and subsequent-use cohorts, respectively. Treatment patterns during the 1-year after treatment initiation were measured as persistence, and discontinuation including restarting, switching, and stopping. The Cox proportional hazard model was used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for discontinuation of biologic treatments.

Results

We identified 4114 patients for the first-use cohort and 992 patients for the subsequent-use cohort. Treatment persistence with adalimumab, etanercept, and infliximab was observed in 52.5%, 56.1%, and 52.6% of the patients, respectively, in the first-use cohort, without significant differences in duration of persistence among the treatments according to the Cox proportional hazard model. In the subsequent-use cohort, treatment persistence with adalimumab, etanercept, infliximab, and abatacept was observed in 45.7%, 58.5%, 43.0%, and 60.4% of the patients, respectively. The Cox proportional hazard model found that the patients who were receiving etanercept (HR = 0.68, 95% CI: 0.52–0.88) and abatacept (HR = 0.53; 95% CI: 0.37–0.74) were significantly less likely to discontinue the treatment than those who were receiving infliximab.

Conclusions

Adalimumab, etanercept, and infliximab had similar levels of persistence during the 1-year after treatment initiation, when used as first-line treatment. However, when used as a subsequent-line treatment, etanercept and abatacept had higher persistence than infliximab or adalimumab. Persistence could be a consideration when selecting the subsequent-line biologic treatment for patients with rheumatoid arthritis in South Korea.

文章出處：

Lee MY, Shin JY, Park SY, Kim D, Cha HS, Lee EK. Seminars in Arthritis and Rheumatism.

https://www.researchgate.net/publication/319408743_Persistence_of_Biologic_Disease-modifying_Antirheumatic_Drugs_in_Patients_with_Rheumatoid_Arthritis_An_analysis_of_the_South_Korean_National_Health_Insurance_Database

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