Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study.

Autor:	Russell MD; Centre for Rheumatic Diseases, King's College London, London, UK., Yang Z; Centre for Rheumatic Diseases, King's College London, London, UK., Dooley N; Centre for Rheumatic Diseases, King's College London, London, 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., 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., 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; NEIAA, Practice & Quality, British Society for Rheumatology, London, UK., Coalwood C; NEIAA, Practice & Quality, 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:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Nov 01. Date of Electronic Publication: 2024 Nov 01.
DOI:	10.1093/rheumatology/keae607
Abstrakt:	Objective: To evaluate temporal and regional variation in biologic and targeted synthetic DMARD (b/tsDMARD) initiation for rheumatoid arthritis (RA) in England and Wales. Methods: An observational cohort study was conducted for people with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and April 2022 who had 12-month follow-up data. Temporal trends in escalation to b/tsDMARDs within 12 months of initial rheumatology assessment were explored, including comparisons before and after publication (July 2021) of national guidelines that lowered the threshold for b/tsDMARD initiation to include moderate-severity RA. Case-mix-adjusted, mixed-effects regression was used to evaluate regional and hospital-level variation in b/tsDMARD initiation. Results: Of 6,098 RA patients with available follow-up, 508 (8.3%) initiated b/tsDMARDs within 12 months of initial assessment. b/tsDMARD escalation increased marginally towards the end of the study period (9.2% in May 2021/22); however, no significant differences were evident after guidelines were published permitting b/tsDMARDs for moderate-severity RA. The proportion of individuals escalated to b/tsDMARDs varied considerably between regions, ranging from 5.1% in Wales to 10.7% in North-West England. Following case-mix adjustment, the intraclass correlation (ICC) for hospitals within regions was 0.17, compared with a between-region ICC of 0.0, suggesting that the observable regional variation reflected hospital-level differences rather than systematic differences between regions themselves. Conclusion: There is marked variation in escalation to b/tsDMARDs for people newly-diagnosed with RA throughout England and Wales, despite a universal healthcare system. These disparities must be addressed if we are to deliver equitable access to b/tsDMARDs, regardless of geography. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
Databáze:	MEDLINE
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