Division of Rheumatology, School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
Clin Ther. 2011 Jul;33(7):901-13. doi: 10.1016/j.clinthera.2011.06.001. Epub 2011 Jun 29.
Biologics are an important addition to the conventional care of patients with rheumatoid arthritis (RA). Poor persistence with and adherence to biologics can undermine the effectiveness of these medications. There are no standardized methods to track persistence with and adherence to biologics.
The goal of this systematic review was to assess the methods of measurement and reported rates of persistence with and adherence to biologic regimens in patients with RA in clinical practice.
Observational studies that evaluated persistence with and adherence to biologic treatments in patients with RA were identified by searching Medline and SCI-Expanded for observational studies published in English between January 1995 and May 2009, using the following search terms: adalimumab, adherence, arthritis, biologics, compliance, discontinuation, etanercept, infliximab, persistence, RA, treatment retention, and TNF. The articles were independently reviewed to identify relevant studies and abstracted data.
Of the 52 studies identified, 73% were based in Europe and 21% were set in the United States. All but 1 study reported measures of persistence, such as median drug survival and rates of discontinuation and retention. Four studies reported on adherence, all of which were conducted in the United States and used administrative claims data. Methods of persistence and adherence measurement were unclear or, if recorded, varied considerably across studies. Although various continuation rates (persistence) were reported across studies, the overall range of continuation at 12 months was 32.0% to 90.9%. Continuation rates were generally higher with the addition of methotrexate or other disease-modifying antirheumatic drugs.
The data from the available studies on RA treatments suggest a need for better methods for tracking persistence and adherence, for examining prescribing patterns, and for identifying interventions to improve adherence.
生物制剂是类风湿关节炎（RA）患者常规治疗的重要补充。生物制剂的坚持使用和依从性差会降低这些药物的疗效。目前还没有标准化的方法来跟踪生物制剂的坚持使用和依从性。
本系统评价的目的是评估临床实践中评估 RA 患者坚持使用和依从生物制剂方案的方法和报告的坚持率和依从率。
通过在 Medline 和 SCI-Expanded 中搜索 1995 年 1 月至 2009 年 5 月期间发表的英文观察性研究，确定了评估 RA 患者坚持使用和依从生物治疗的观察性研究，使用以下搜索词：阿达木单抗、依从性、关节炎、生物制剂、顺应性、停药、依那西普、英夫利昔单抗、坚持、RA、治疗保留和 TNF。这些文章由独立评审员进行审查，以确定相关研究并提取数据。
在确定的 52 项研究中，73%来自欧洲，21%来自美国。除了 1 项研究外，所有研究都报告了坚持率的衡量标准，如药物生存中位数和停药率及保留率。有 4 项研究报告了依从性，这些研究均在美国进行，使用的是行政索赔数据。坚持和依从性测量的方法不明确，或者如果有记录，也因研究而异。尽管各个研究报告了不同的持续率（坚持率），但在 12 个月时的总体持续率范围为 32.0%至 90.9%。与添加甲氨蝶呤或其他疾病修正抗风湿药物相比，持续率通常更高。
现有 RA 治疗研究的数据表明，需要更好的方法来跟踪坚持和依从性，检查处方模式，并确定改善依从性的干预措施。
