OptumInsight, 12125 Technology Drive, Eden Prairie, MN 55344, USA.
Adv Ther. 2012 Aug;29(8):691-7. doi: 10.1007/s12325-012-0039-3. Epub 2012 Aug 16.
Treatment patterns, including persistence, gaps in therapy, switching, and discontinuation, were examined in patients with psoriatic arthritis (PsA) who received the tumor necrosis factor (TNF)-blockers etanercept or adalimumab.
This retrospective study utilized administrative claims data from a United States commercial health plan. Adults (age 18-64 years) with PsA who started therapy with etanercept or adalimumab as index therapy between January 1, 2006 and December 31, 2008 were included in the analysis. Patients were continuously enrolled in the health plan for at least 6 months before and at least 12 months after the start of index therapy. Initial TNF-blocker dose and rates of therapy persistence (continuous use of index medication without a gap of at least 60 days), therapy gaps, and discontinuation (gap in therapy of at least 60 days) were estimated. Those who discontinued were further classified as: (1) discontinued all biologic therapy, (2) restarted index medication, (3) switched to another biologic therapy, or (4) other.
A total of 346 patients with PsA (202 etanercept, 144 adalimumab) were eligible. Most (90.6% etanercept; 88.9% adalimumab) started index therapy at the labeled dose. Persistence with index therapy for 12 months was observed in 50% of patients on etanercept and 45% of patients on adalimumab (P = 0.37). Patients on etanercept had a longer duration of persistence (434 vs. 353 days; P = 0.02), more pauses of at least 7 days (4.7 vs. 3.5; P = 0.004), and a longer mean pause length (48.6 vs. 29.3 days; P = 0.01) than patients on adalimumab. Of patients who discontinued (24.8% etanercept; 35.1% adalimumab), 46.4% and 41.5% restarted etanercept and adalimumab, respectively; 24.8% and 35.1% discontinued all TNF-blockers; 20.0% and 19.2% switched to another biologic; and 8.8% and 4.3% had other therapy changes.
Approximately half of PsA patients were persistent on their index TNF-blocker for 12 months. Pauses in therapy and therapy discontinuation were common, but more than 40% of patients restarted their index TNF-blocker after discontinuation.
本研究旨在评估接受肿瘤坏死因子（TNF）抑制剂依那西普或阿达木单抗治疗的银屑病关节炎（PsA）患者的治疗模式，包括持续性、治疗中断、换药和停药。
本回顾性研究利用了美国商业健康计划的行政索赔数据。纳入 2006 年 1 月 1 日至 2008 年 12 月 31 日期间开始接受依那西普或阿达木单抗治疗作为索引治疗的年龄在 18-64 岁之间的 PsA 成年患者。患者在索引治疗开始前至少连续 6 个月和开始后至少 12 个月均需连续参加健康计划。估计初始 TNF 抑制剂剂量和治疗持续性（持续使用索引药物，无至少 60 天的间隔）、治疗中断和停药（至少 60 天的治疗间隔）的发生率。停药患者进一步分为：（1）停止所有生物制剂治疗；（2）重新开始索引药物治疗；（3）换用另一种生物制剂；或（4）其他。
共有 346 名 PsA 患者（依那西普 202 例，阿达木单抗 144 例）符合条件。大多数患者（依那西普 90.6%；阿达木单抗 88.9%）开始接受标签剂量的索引治疗。依那西普组 12 个月治疗持续性为 50%，阿达木单抗组为 45%（P=0.37）。依那西普组的持续时间更长（434 天 vs. 353 天；P=0.02），至少 7 天的暂停次数更多（4.7 次 vs. 3.5 次；P=0.004），平均暂停时间更长（48.6 天 vs. 29.3 天；P=0.01）。停止治疗的患者中（依那西普 24.8%，阿达木单抗 35.1%），分别有 46.4%和 41.5%的患者重新开始使用依那西普和阿达木单抗；24.8%和 35.1%的患者停止了所有 TNF 阻滞剂治疗；20.0%和 19.2%的患者换用了另一种生物制剂；8.8%和 4.3%的患者接受了其他治疗。
约一半的 PsA 患者在 12 个月内持续使用其索引 TNF 抑制剂。治疗中断和停药很常见，但超过 40%的停药患者重新开始使用其索引 TNF 抑制剂。
