Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study.

Autor:	Russell MD; Centre for Rheumatic Diseases, King's College London, London, UK. Electronic address: mark.russell@kcl.ac.uk., Gibson M; Centre for Rheumatic Diseases, King's College London, London, UK., Zuckerman B; Centre for Rheumatic Diseases, King's College London, London, UK., Kumar K; Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Royal Wolverhampton NHS Trust, Wolverhampton, UK., Dubey S; Department of Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK., Adas MA; Centre for Rheumatic Diseases, King's College London, London, UK., Alveyn E; Centre for Rheumatic Diseases, King's College London, London, UK., Patel S; Centre for Rheumatic Diseases, King's College London, London, UK., Yang Z; Centre for Rheumatic Diseases, King's College London, London, UK., Bechman K; Centre for Rheumatic Diseases, King's College London, London, UK., Price E; Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK., Gallagher S; British Society for Rheumatology, London, UK., Cope AP; Centre for Rheumatic Diseases, King's College London, London, UK., Norton S; Centre for Rheumatic Diseases, King's College London, London, UK., Galloway JB; Centre for Rheumatic Diseases, King's College London, London, UK.
Jazyk:	angličtina
Zdroj:	The Lancet. Rheumatology [Lancet Rheumatol] 2024 Oct 15. Date of Electronic Publication: 2024 Oct 15.
DOI:	10.1016/S2665-9913(24)00221-2
Abstrakt:	Background: Quantifying health-care inequality is essential to addressing the imbalance in outcomes attributable to age, sex, race or ethnicity, and multimorbidity. In this study, we analysed differences in the initiation of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis within the universal health-care system of England and Wales, UK. Methods: An observational cohort study was conducted using the National Early Inflammatory Arthritis Audit (NEIAA) dataset. We included all patients with rheumatoid arthritis who were enrolled in NEIAA between May 8, 2018, and April 30, 2022, and who had 12-month follow-up data available. Modified Poisson regression was used to explore factors associated with the initiation of biological and targeted synthetic DMARDs within 12 months of initial rheumatology assessment. The factors evaluated included age, sex, ethnicity, socioeconomic status (index of multiple deprivation), smoking status, and relevant comorbidities (lung disease, cardiovascular disease, cancer, and depression). NEIAA is supported by people with lived experience of rheumatoid arthritis, who contributed to study design and the interpretation of findings. Findings: 6098 patients in NEIAA had new diagnoses of rheumatoid arthritis and available follow-up data. The mean age was 59·2 years (SD 14·9); 3912 (64·2%) patients were women and 2186 (35·8%) were men. 6047 (99·2%) patients had available ethnicity data, of whom 5215 (86·2%) were White, 152 (2·5%) were Black, 478 (7·9%) were Asian, and 202 (3·3%) were of mixed or other ethnicities. 508 (8·3%) of 6098 patients initiated biological and targeted synthetic DMARDs within 12 months. Patients younger than 40 years were more likely to be initiated on biological and targeted synthetic DMARDs than individuals older than 65 years (multivariable-adjusted risk ratio 2·41 [95% CI 1·83-3·19]; p<0·0001). Asian individuals were less likely to be initiated on biological and targeted synthetic DMARDs than White individuals (0·52 [0·36-0·76]; p=0·0007), which persisted after adjustment for socioeconomic status, comorbidities, baseline disease severity, and the initial response to conventional synthetic DMARDs. These differences were evident for Asian women but not Asian men. Black individuals were more likely to be initiated on biological and targeted synthetic DMARDs than White individuals (1·54 [1·10-2·16]; p=0·012), which became non-significant after adjusting for baseline disease severity and autoantibody status. Interpretation: The initiation of biological and targeted synthetic DMARDs for patients with newly diagnosed rheumatoid arthritis varies markedly by ethnicity and age in the universal health-care system of England and Wales. This study demonstrates the importance of providing tailored information and ensuring equitable access to high-quality care for underserved patient groups. The one-size-fits-all approach must be reconsidered if health disparities are to be mitigated effectively. Funding: Sandoz UK. Competing Interests: Declaration of interests JBG has received honoraria from AbbVie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi, and UCB; and grant funding from Sandoz UK. MDR has received honoraria from AbbVie, Lilly, Galapagos, Menarini, UCB, and Viforpharma; grant funding from Sandoz UK; advisory board fees from Biogen; and support for attending educational meetings from Lilly, Pfizer, Janssen, and UCB. APC has received grant funding from BMS; consulting fees from Galvani/GSK, BMS, UCB, and Janssen; honoraria from Galapagos, AbbVie, and BMS; support for attending meetings from AbbVie; and has participated in a data or advisory board for Galvani/GSK. KB has received grant funding from the National Institute for Health and Care Research; honoraria from Galapagos, UCB, and Viforpharma; and educational support from UCB. EA has received support for attending meetings from UCB. All other authors declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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