Uptake and Clinical Utility of Multibiomarker Disease Activity Testing in the United States
| Autor: | Shuo Yang, Lang Chen, Maria I. Danila, Justin K. Owensby, Fenglong Xie, Jeffrey R. Curtis |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
030203 arthritis & rheumatology
Oncology medicine.medical_specialty business.industry Immunology Treatment outcome Confounding medicine.disease Disease activity 03 medical and health sciences 0302 clinical medicine Rheumatology Medication Persistence Rheumatoid arthritis Internal medicine Immunology and Allergy Medicine Biomarker (medicine) 030212 general & internal medicine business Janus kinase Routine care |
| Zdroj: | The Journal of Rheumatology. 46:237-244 |
| ISSN: | 1499-2752 0315-162X |
| Popis: | Objective.The clinical utility of the multibiomarker disease activity (MBDA) test for rheumatoid arthritis (RA) management in routine care in the United States has not been thoroughly studied.Methods.Using 2011–2015 Medicare data, we linked each patient with RA to their MBDA test result. Initiation of a biologic or Janus kinase (JAK) inhibitor in the 6 months following MBDA testing was described. Multivariable adjustment evaluated the likelihood of adding or switching biologic/JAK inhibitor, controlling for potential confounders. For patients with high MBDA scores who added a new RA therapy and were subsequently retested, lack of improvement in the MBDA score was evaluated as a predictor of future RA medication failure, defined by the necessity to change RA medications again.Results.Among 60,596 RA patients with MBDA testing, the proportion adding or switching biologics/JAK inhibitor among those not already taking a biologic/JAK inhibitor was 9.0% (low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Similarly, among those already taking biologics/JAK inhibitor, the proportions were 5.2%, 8.3%, and 13.5% (p < 0.0001). After multivariable adjustment, referent to those with low disease MBDA scores, the likelihood of switching was 1.51-fold greater (95% CI 1.35–1.69) for patients with moderate MBDA scores, and 2.62 (2.26–3.05) for patients with high MBDA scores. Among those with high MBDA scores who subsequently added a biologic/JAK inhibitor and were retested, lack of improvement in the MBDA score category was associated with likelihood of future RA treatment failure (OR 1.61, 95% CI 1.27–2.03).Conclusion.The MBDA score was associated with both biologic and JAK inhibitor medication addition/switching and subsequent treatment outcomes. |
| Databáze: | OpenAIRE |
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