Lee Wan-Ju, Briars Leslie, Lee Todd A, Calip Gregory S, Suda Katie J, Schumock Glen T
Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
Pharmacotherapy. 2016 Dec;36(12):1201-1209. doi: 10.1002/phar.1856. Epub 2016 Dec 4.
To characterize the use of tumor necrosis factor-α inhibitors (TNFIs) in children with juvenile idiopathic arthritis (JIA) and young adults with rheumatoid arthritis (RA).
Patients with incident JIA or RA were identified by using the Truven Health MarketScan Commercial Claims and Encounters database from 2009 to 2013. The incident diagnosis was defined as no prior claims with a JIA/RA code and no JIA/RA medications recorded during the previous 6 months. TNFI use patterns were examined, including switching among TNFIs, adherence, persistence, and time from diagnosis to TNFI use. Earlier TNFI treatment without prior use of traditional disease-modifying antirheumatic drugs (DMARDs) and use of specific TNFIs were analyzed by age group.
Of 6929 children and young adults with new diagnoses of JIA/RA, 18.6% were treated with TNFIs. In these TNFI users, 39.1% received earlier TNFI therapy without prior use of DMARDs. The use of TNFIs was higher in patients diagnosed between 2012 and 2013 than that in patients diagnosed between 2009 and 2011 (hazard ratio 1.13, 95% confidence interval 1.00-1.28). Etanercept was the most commonly used, especially by children aged < 12 (75.5%) and adolescents aged 12 to 17 (62.5%) years. Adherence measured as mean proportion of days covered ranged from 70.4% to 93.2% for individual TNFI agents. Only about 60% of patients continuously took TNFIs for 12 months. When switching occurred, switching from etanercept to adalimumab was the most common pattern.
Earlier TNFI therapy was observed in 39.1% of children and young adults taking TNFIs. In addition, the time to the first TNFI prescription became shorter over the study period. Future research should evaluate the long-term effectiveness and safety of this more aggressive TNFI therapy.
描述肿瘤坏死因子-α抑制剂（TNFIs）在幼年特发性关节炎（JIA）儿童和类风湿关节炎（RA）青年成人中的使用情况。
利用2009年至2013年的Truven Health MarketScan商业索赔和病历数据库确定JIA或RA新发病例。新发病例定义为之前没有JIA/RA编码的索赔记录且在前6个月内没有记录JIA/RA药物治疗情况。检查了TNFI的使用模式，包括在TNFIs之间的转换、依从性、持续性以及从诊断到使用TNFI的时间。按年龄组分析了在未预先使用传统改善病情抗风湿药物（DMARDs）的情况下更早使用TNFI治疗以及特定TNFIs的使用情况。
在6929例新诊断为JIA/RA的儿童和青年成人中，18.6%接受了TNFIs治疗。在这些使用TNFI的患者中，39.1%在未预先使用DMARDs的情况下接受了更早的TNFI治疗。2012年至2013年诊断的患者中TNFIs的使用高于2009年至2011年诊断的患者（风险比1.13，95%置信区间1.00 - 1.28）。依那西普是最常用的，尤其是在12岁以下儿童（75.5%）和12至17岁青少年（62.5%）中。以覆盖天数的平均比例衡量的个体TNFI药物的依从性范围为70.4%至93.2%。只有约60%的患者持续服用TNFI达12个月。当发生转换时，从依那西普转换为阿达木单抗是最常见的模式。
在使用TNFIs的儿童和青年成人中，39.1%观察到更早使用TNFI治疗。此外，在研究期间首次开具TNFI处方的时间变短。未来的研究应评估这种更积极的TNFI治疗的长期有效性和安全性。
