Kamal Khalid M, Madhavan S Suresh, Hornsby Jo Ann Allen, Miller Lesley-Ann, Kavookjian Jan, Scott Virginia
Department of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy, Bayer Learning Center, 600 Forbes Avenue, Duquesne University, Pittsburgh, PA 15282, USA.
Joint Bone Spine. 2006 Dec;73(6):718-24. doi: 10.1016/j.jbspin.2006.05.002. Epub 2006 Aug 28.
To determine the prescribing practices, laboratory monitoring protocols, and perceived barriers of United States rheumatologists in prescribing tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA).
A survey questionnaire was mailed to 1970 rheumatologists who were randomly selected from a national sample of 3008 rheumatologists. A one-page non-response questionnaire was mailed to approximately 200 randomly selected non-responding rheumatologists to assess non-response bias.
Two mailings yielded a response rate of 22.3% (428 completed, usable surveys out of 1922 deliverable surveys). Rheumatologists reported using all three agents in patients with moderate RA (82-87%), severe RA (94-96%), and in newly diagnosed and mild RA patients (10-18%). In patients with severe RA who inadequately responded to methotrexate, 91% of rheumatologists reported using a TNF inhibitor with one other disease modifying anti-rheumatic drug. Over 94% of rheumatologists reported switching patients from one TNF inhibitor to a different TNF inhibitor due to inadequate response or side effects. Most rheumatologists (96%) ordered the purified protein derivative test for tuberculosis, with almost 82% conducting this test at baseline. Costs to patients and insurance coverage were perceived as major barriers to prescribing these agents although the perception was slightly lower with infliximab than with adalimumab or etanercept.
The use of TNF inhibitors is not restricted to patients with moderate and severe RA. Rheumatologists are fairly similar in their utilization of the three TNF inhibitors although some variation exists in terms of laboratory practices and perceived barriers regarding the use of these agents.
确定美国风湿病学家在类风湿关节炎（RA）中开具肿瘤坏死因子（TNF）抑制剂的处方习惯、实验室监测方案以及感知到的障碍。
向从3008名风湿病学家的全国样本中随机选取的1970名风湿病学家邮寄调查问卷。向大约200名随机选取的未回复的风湿病学家邮寄一份单页的无回复调查问卷，以评估无回复偏差。
两次邮寄的回复率为22.3%（1922份可投递调查问卷中有428份完成且可用的调查问卷）。风湿病学家报告在中度RA患者（82 - 87%）、重度RA患者（94 - 96%）以及新诊断的轻度RA患者（10 - 18%）中使用所有三种药物。在对甲氨蝶呤反应不佳的重度RA患者中，91%的风湿病学家报告使用一种TNF抑制剂联合另一种改善病情的抗风湿药物。超过94%的风湿病学家报告因反应不佳或副作用而将患者从一种TNF抑制剂换用另一种TNF抑制剂。大多数风湿病学家（96%）开具结核菌素纯蛋白衍生物试验，近82%在基线时进行该试验。患者费用和保险覆盖被视为开具这些药物的主要障碍，尽管英夫利昔单抗的这种感知略低于阿达木单抗或依那西普。
TNF抑制剂的使用不限于中度和重度RA患者。风湿病学家在三种TNF抑制剂的使用方面相当相似，尽管在实验室操作以及对这些药物使用的感知障碍方面存在一些差异。
