Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
Value Health. 2010 Sep-Oct;13(6):805-12. doi: 10.1111/j.1524-4733.2010.00764.x.
This study examined adherence, discontinuation, and switching of rheumatoid arthritis (RA) biologics over a 1-year period after initiation of the biologic treatment in Medicaid patients with RA.
The study sample consisted of Medicaid patients with RA in California, Florida and New York who had newly initiated etanercept (n=1359), anakinra (n=267), or infliximab (n=1012) between January 1, 2000 and December 31, 2002. Adherence (proportion of days covered (PDC)≥0.80), discontinuation (90-day continuous gap), and switching (initiation of second biologic within 90days of discontinuation date of index biologic) were measured during the 12-month postindex biologic initiation. Sensitivity analyses were conducted by varying the thresholds to define these measures. Logistic regressions examined the factors associated with RA biologic adherence and discontinuation.
Anakinra users had the lowest mean PDC (0.36) and percent adherent patients (11%) followed by etanercept users (mean PDC: 0.57; % adherent: 32%) and infliximab users (mean PDC: 0.64; % adherent: 43%). All three groups had high discontinuation rates (41% etanercept, 76% anakinra, and 41% infliximab). Few patients who discontinued the index biologic switched to another biologic. Logistic regressions found that patients in Florida had lower odds of being adherent and higher odds of discontinuing their index biologic than patients in California. Anakinra users had lower odds and infliximab users had higher odds of being adherent than etanercept users. Anakinra users had higher odds of discontinuation than etanercept users.
This study highlights the poor adherence to and premature discontinuation without concurrent switching of RA biologics that should raise concern for clinicians as well as payers.
本研究旨在考察在接受生物制剂治疗的 1 年内，加利福尼亚州、佛罗里达州和纽约州的医疗补助计划（Medicaid）类风湿关节炎（RA）患者在开始使用生物制剂后，对生物制剂的依从性、停药和换药情况。
研究样本包括 2000 年 1 月 1 日至 2002 年 12 月 31 日期间新开始使用依那西普（n = 1359）、阿那白滞素（n = 267）或英夫利昔单抗（n = 1012）的患有 RA 的 Medicaid 患者。在开始使用索引生物制剂后的 12 个月内，通过测定患者的（用药覆盖天数比例（PDC）≥0.80）、停药（90 天连续缺口）和换药（索引生物制剂停药日期后 90 天内开始使用第二种生物制剂）来评估其依从性。通过改变这些定义措施的阈值进行敏感性分析。使用逻辑回归检验与 RA 生物制剂的依从性和停药相关的因素。
阿那白滞素使用者的平均 PDC（0.36）和依从性患者比例（11%）最低，其次是依那西普使用者（平均 PDC：0.57%；依从性患者比例：32%）和英夫利昔单抗使用者（平均 PDC：0.64%；依从性患者比例：43%）。所有三组患者的停药率均较高（依那西普组为 41%，阿那白滞素组为 76%，英夫利昔单抗组为 41%）。很少有患者在停止使用索引生物制剂后改用另一种生物制剂。逻辑回归发现，佛罗里达州的患者依从性较低，停止使用索引生物制剂的可能性更高，而加利福尼亚州的患者则相反。与依那西普使用者相比，阿那白滞素使用者的依从性更低，英夫利昔单抗使用者的依从性更高。与依那西普使用者相比，阿那白滞素使用者停药的可能性更高。
本研究强调了 RA 生物制剂的依从性差、过早停药且无同时换药的现象，这应引起临床医生和支付方的关注。
