Patient characteristics influence the choice of biological drug in RA, and will make non-TNFi biologics appear more harmful than TNFi biologics

Autor: Thomas Frisell, Johan Askling, Eva Baecklund, Karin Bengtsson, Daniela Di Giuseppe, Helena Forsblad-d'Elia
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
rheumatoid arthritis
Choice Behavior
Severity of Illness Index
Arthritis
Rheumatoid
chemistry.chemical_compound
0302 clinical medicine
Immunology and Allergy
Registries
030212 general & internal medicine
Drug Substitution
Middle Aged
health services research
Treatment Outcome
Antirheumatic Agents
Rheumatoid arthritis
Regression Analysis
Female
Rituximab
epidemiology
medicine.drug
Adult
medicine.medical_specialty
Immunology
Antibodies
Monoclonal
Humanized
Risk Assessment
General Biochemistry
Genetics and Molecular Biology
Abatacept
outcomes research
03 medical and health sciences
Age Distribution
Tocilizumab
Rheumatology
Internal medicine
Severity of illness
medicine
Humans
Medical history
Sex Distribution
Aged
Rheumatology and Autoimmunity
Sweden
030203 arthritis & rheumatology
Biological Products
Reumatologi och inflammation
Tumor Necrosis Factor-alpha
business.industry
dmards (biologic)
Clinical and Epidemiological Research
medicine.disease
Social Class
chemistry
Relative risk
Multivariate Analysis
Outcomes research
business
Zdroj: Annals of the Rheumatic Diseases
Popis: ObjectivesWith the wide range of biological disease-modifying anti-rheumatic drugs (bDMARDs) available for treating rheumatoid arthritis (RA), and limited evidence to guide the choice for individual patients, we wished to evaluate whether patient characteristics influence the choice of bDMARD in clinical practice, and to quantify the extent to which this would bias direct comparisons of treatment outcome.MethodsRegister-based study of all Swedish patients with RA initiating necrosis factor inhibitor (TNFi), rituximab, abatacept or tocilizumab in 2011–2015 as their first bDMARD (n=6481), or after switch from TNFi as first bDMARD (n=2829). Group differences in demographics, clinical characteristics and medical history were assessed in multivariable regression models. Predicted differences in safety and treatment outcomes were calculated as a function of patient characteristics, through regression modelling based on observed outcomes among patients with RA starting bDMARDs 2006–2010.ResultsPatients starting non-TNFi were older than those starting TNFi, had lower socioeconomic status, higher disease activity and higher burden of diseases including malignancy, serious infections and diabetes. Differences were most pronounced at first bDMARD initiation. These factors were linked to treatment outcome independent of therapy, yielding worse apparent safety and effectiveness for non-TNFi biologics, most extreme for rituximab. Standardising to the age/sex distribution of the TNFi group reduced differences considerably.ConclusionsThere was significant channelling of older and less healthy patients with RA to non-TNFi bDMARDs, in particular as first bDMARD. Whether this channelling represents a maximised benefit/risk ratio is unclear. Unless differences in age, medical history and disease activity are accounted for, they will substantially confound non-randomised comparative studies of available bDMARDs’ safety and effectiveness.
Databáze: OpenAIRE
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