Comparative effectiveness of treatment with the first TNF antagonist in monotherapy, the first TNF antagonist plus one conventional synthetic disease-modifying antirheumatic drug, and the first TNF antagonist plus two or more conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis
| Autor: | Rafael Caliz-Caliz, F. Navarro-Sarabia, Blanca Hernández-Cruz, Esther Márquez-Saavedra |
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| Přispěvatelé: | [Hernández-Cruz,B, Navarro-Sarabia,F] Rheumatology Clinical Unit, Virgen de la Macarena University Hospital, Andalusian Health Service, Seville, Spain. [Márquez-Saavedra,E] Pharmaceutical Supplies and Services, Central Services, Reina Sofia University Hospital, Andalusian Health Service, Cordoba, Spain. [Caliz-Caliz,R] Rheumatologist, Head of Service., Virgen de las Nieves University Hospital, Andalusian Health Service, Granada, Spain., This work was funding by a limited grant from the Andalucian Foundation of Rheumatology. |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_treatment Pharmacology Gastroenterology Chemicals and Drugs::Biological Factors [Medical Subject Headings] Arthritis Rheumatoid Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] 0302 clinical medicine Prednisone Health Care::Health Care Quality Access and Evaluation::Quality of Health Care::Epidemiologic Factors::Comorbidity [Medical Subject Headings] 030212 general & internal medicine Prospective Studies Practice Patterns Physicians' Prospective cohort study Middle Aged Antirheumatic Agents Treatment Outcome Antirreumáticos Rheumatoid arthritis csDMARDs Toxicity Female TNF antagonist medicine.drug Research Article Adult medicine.medical_specialty Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings] Artritis reumatoide Factores biológicos Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antirheumatic Agents [Medical Subject Headings] 03 medical and health sciences Internal medicine Diseases::Musculoskeletal Diseases::Joint Diseases::Arthritis::Arthritis Rheumatoid [Medical Subject Headings] medicine Humans Disease-modifying antirheumatic drug Glucocorticoides Glucocorticoids Aged 030203 arthritis & rheumatology business.industry Tumor Necrosis Factor-alpha medicine.disease Rheumatology Chemicals and Drugs::Complex Mixtures::Biological Products [Medical Subject Headings] Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienediols::Prednisone [Medical Subject Headings] Chemicals and Drugs::Hormones Hormone Substitutes and Hormone Antagonists::Hormones::Adrenal Cortex Hormones::Glucocorticoids [Medical Subject Headings] Check Tags::Female [Medical Subject Headings] Concomitant business RA |
| Zdroj: | Arthritis Research & Therapy |
| Popis: | Journal Article; BACKGROUND Rheumatoid arthritis (RA) patients are treated with a mean of 3-4 conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) with or without glucocorticoids (GCs), before the first biologic prescription. The main reasons for change are inefficacy in 30-40 % of patients, and toxicity ≈ 10 %. Thus, they are treated with the first TNF antagonists in monotherapy. The aim of this study was to analyse the csDMARD and GC prescription patterns before and during treatment with the first TNF antagonist, and compare their effectiveness in three groups of patients. METHODS An observational, prospective, multicentre study in common clinical practice was designed. Treating rheumatologists recorded patient variables, including previous and concomitant csDMARDs and GCs in a database. The data were analysed using descriptive, inferential and multivariate statistics. RESULTS There were 1136 patients included; 21 % received the first TNF antagonist in monotherapy, 67 % received the first TNF antagonist plus one csDMARD, and 12 % the first TNF antagonist plus two or more csDMARDs. Most patients were female (73 %), RF+, and ACPA+, and had erosions; mean age was 53.2 (±13.0) years, and duration of disease was 9.1 (±7.6) years. They had high activity with DAS28 of 5.8 ± 1.1, and poor physical function with HAQ of 1.43 ± 0.63, and significant differences between groups in clinical variables and comorbidities; 94 % had received treatment with GCs, MTX, LFN, or SSZ at any time before the first TNF antagonist, 5 % (n = 52) had been treated with CLQ or HCLQ, and 1 % (n = 13) had received neither GCs nor csDMARDs. Before the first TNF antagonist, the drugs most commonly used were GCs (78 %), MTX (50 %), LFN (44 %), and SSZ (21 %). Concomitantly with the first TNF antagonist, 977 patients (85 %) were receiving GCs, MTX, LFN, or SSZ; 15 % (n = 173) received their first TNF antagonist without any concomitant GCs or csDMARDs, true monotherapy, and 6 % received their first TNF antagonist with GCs. The drug most commonly used at the time of first TNF antagonist initiation was MTX (58 %). All treatment groups had clinically and statistically significant improvements in DAS and HAQ scores. Effectiveness analysis (controlling for confounders) showed mean drug survival of 16.7, 20.1 and 11.7 months in each group, respectively (p |
| Databáze: | OpenAIRE |
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