Cannon Grant W, DuVall Scott L, Haroldsen Candace L, Caplan Liron, Curtis Jeffrey R, Michaud Kaleb, Mikuls Ted R, Reimold Andreas, Collier David H, Harrison David J, Joseph George J, Sauer Brian C
From the Veterans Affairs Salt Lake City Health Care System; University of Utah School of Medicine, Salt Lake City, Utah; Denver Veterans Affairs (VA); University of Colorado, Denver, Colorado; University of Alabama at Birmingham, Birmingham, Alabama; the University of Nebraska Medical Center; Omaha VA, Omaha, Nebraska; the National Data Bank for Rheumatic Diseases, Wichita, Kansas; Dallas VA; University of Texas Southwestern, Dallas, Texas; Amgen Inc., Thousand Oaks, California, USA.G.W. Cannon, MD, Associate Chief of Staff of Academic Affiliations; S.L. DuVall, PhD, Associate Director, VA Informatics and Computing Infrastructure and Research Assistant Professor; C.L. Haroldsen, MSPH, Senior Programmer/Analyst; B.C. Sauer, PhD, MS, Associate Professor, Veterans Affairs Salt Lake City Health Care System, University of Utah School of Medicine; L. Caplan, MD, PhD, Associate Professor of Medicine/Rheumatology, Denver VA, University of Colorado; J.R. Curtis, MD, MS, MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology, Director, University of Alabama Birmingham (UAB) Arthritis Clinical Intervention Program, Co-director, UAB Center for Education and Research on Therapeutics, Co-director, UAB PharmacoEpidemiology and Economic Research Group, University of Alabama at Birmingham; K. Michaud, PhD, Assistant Professor of Medicine, Co-director, University of Nebraska Medical Center, National Data Bank for Rheumatic Diseases; T.R. Mikuls, MD, Staff Physician and Researcher, Professor of Internal Medicine and Rheumatology, Omaha VA, University of Nebraska Medical Center; A. Reimold, MD, Chief, Rheumatology Section, Associate Professor of Medicine, Dallas VA, University of Texas Southwestern; D.H. Collier, MD, Clinical Research Medical Director; D.J. Harrison, PhD, Health Economics Director, Amgen Inc.; G.J. Joseph, PhD, Health Economics Senior Manager, former employee of Amgen Inc.
J Rheumatol. 2014 Oct;41(10):1935-43. doi: 10.3899/jrheum.140164. Epub 2014 Aug 15.
Limited evidence exists comparing the persistence, effectiveness, and costs of biologic therapies for rheumatoid arthritis in clinical practice. Comparative effectiveness studies are needed to understand real-world experience with these agents. We evaluated treatment patterns, costs, and effectiveness of tumor necrosis factor inhibitor (TNFi) agents in patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry.
Observational data from the VARA registry and linked administrative databases were analyzed. Longitudinal data from VARA patients initiating adalimumab (ADA), etanercept (ETN), or infliximab (IFX) from 2003 (the date all agents were available within the Veteran Affairs) to 2010 were analyzed. Outcomes included Disease Activity Score using 28 joints (DAS28), treatment persistence, dose escalation, and direct costs of drugs and drug administration.
For 563 eligible patients, baseline DAS28, DAS28 improvements, and persistence on initial treatment were similar across agents. Fewer patients receiving ETN (n = 5/290; 2%) underwent dose escalation than did patients taking ADA (n = 32/204; 16%) or IFX (n = 44/69; 64%). Annual costs for first course of TNFi therapy were lower for injectable ADA ($13,100 US) and ETN ($13,500 US) than for intravenously administered IFX ($16,900 US).
Despite similar persistence and clinical disease activity for these TNFi agents, rates of dose escalation were highest with ADA and IFX. Higher overall costs were noted for IFX without increases in effectiveness.
在临床实践中，比较类风湿关节炎生物疗法的持久性、有效性和成本的证据有限。需要进行比较有效性研究以了解这些药物的实际应用情况。我们评估了参加退伍军人事务类风湿关节炎（VARA）登记处的患者中肿瘤坏死因子抑制剂（TNFi）药物的治疗模式、成本和有效性。
分析了来自VARA登记处和相关行政数据库的观察数据。分析了2003年（所有药物在退伍军人事务部均可获得的日期）至2010年开始使用阿达木单抗（ADA）、依那西普（ETN）或英夫利昔单抗（IFX）的VARA患者的纵向数据。结果包括使用28个关节的疾病活动评分（DAS28）、治疗持久性、剂量递增以及药物和药物给药的直接成本。
对于563名符合条件的患者，各药物的基线DAS28、DAS28改善情况以及初始治疗的持久性相似。接受ETN治疗的患者（n = 5/290；2%）中进行剂量递增的人数少于接受ADA治疗的患者（n = 32/204；16%）或IFX治疗的患者（n = 44/69；64%）。TNFi治疗第一疗程的年度成本，注射用ADA（13,100美元）和ETN（13,500美元）低于静脉注射IFX（16,900美元）。
尽管这些TNFi药物的持久性和临床疾病活动情况相似，但ADA和IFX的剂量递增率最高。IFX的总体成本较高，但有效性并未提高。
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