SCQM-RA , Switzerland ; Geneva University , Geneva , Switzerland.
Geneva University , Geneva , Switzerland.
RMD Open. 2015 Apr 30;1(1):e000040. doi: 10.1136/rmdopen-2014-000040. eCollection 2015.
There are substantial differences in accessibility to biological disease modifying antirheumatic drugs (bDMARDs) across countries. The objective of this study was to analyse the impact of patient demographics, disease characteristics and gross domestic product (GDP) on abatacept (ABA) retention in patients with rheumatoid arthritis (RA) treated in clinical practice.
Data from nine European observational RA cohorts of patients treated with ABA were pooled. Kaplan-Meier analysis was used to compare drug retention across registries. Specific causes of drug retention were investigated using competing risks multivariate Cox regression.
A total of 3961 patients treated with ABA, with 6188 patient-years of follow-up, were included. Patients in the different national registries had similar demographic features, but varied in baseline disease characteristics. ABA drug retention differed between countries, with median drug retention rates ranging from 1.2 to more than 6 years. The differences in drug retention were marginally explained by disparities in disease characteristics, while the national GDP per capita was strongly associated with drug retention (correlation coefficient -0.74; p=0.02).
Patient characteristics at ABA initiation vary across Europe, probably reflecting differences in eligibility criteria and prescription patterns. However, the difference in ABA drug retention between countries was not primarily explained by disparities in patient characteristics. Lower ABA retention was observed in countries with a more liberal access to bDMARDs and higher GDP. National differences need to be accounted for when pooling data on treatment with bDMARDs from various countries.
各国间生物改善病情抗风湿药物（bDMARDs）的可及性存在显著差异。本研究旨在分析患者人口统计学特征、疾病特征和国内生产总值（GDP）对临床实践中接受阿巴西普（ABA）治疗的类风湿关节炎（RA）患者 ABA 保留率的影响。
对接受 ABA 治疗的 9 个欧洲 RA 观察性队列的患者数据进行汇总分析。使用 Kaplan-Meier 分析比较各登记处的药物保留率。使用竞争风险多变量 Cox 回归分析调查药物保留的具体原因。
共纳入 3961 例接受 ABA 治疗、随访 6188 患者年的患者。不同国家登记处的患者具有相似的人口统计学特征，但基线疾病特征存在差异。各国之间的 ABA 药物保留率存在差异，中位药物保留率范围为 1.2 年至 6 年以上。药物保留率的差异部分可由疾病特征的差异来解释，而人均 GDP 与药物保留率密切相关（相关系数-0.74；p=0.02）。
ABA 起始时患者特征在欧洲存在差异，可能反映了资格标准和处方模式的差异。然而，各国之间 ABA 药物保留率的差异并非主要由患者特征的差异来解释。在 bDMARD 更自由获得和 GDP 更高的国家，ABA 保留率较低。在汇总来自不同国家的 bDMARD 治疗数据时，需要考虑国家差异。
