Chastek Benjamin, Becker Laura K, Chen Chieh-I, Mahajan Puneet, Curtis Jeffrey R
a Optum , Eden Prairie , MN , USA.
b Regeneron Pharmaceuticals, Inc , Tarrytown , NY , USA.
J Med Econ. 2017 May;20(5):464-473. doi: 10.1080/13696998.2016.1275653. Epub 2017 Jan 4.
To examine treatment patterns, treatment effectiveness, and treatment costs for 1 year after patients with rheumatoid arthritis switched from a tumor necrosis factor inhibitor (TNFi) (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab), either cycling to another TNFi ("TNFi cyclers") or switching to a new mechanism of action (abatacept, tocilizumab, or tofacitinib) ("new MOA switchers").
This retrospective cohort study used administrative claims data for a national insurer. Treatment persistence (without switching again, restarting, or discontinuing), treatment effectiveness (defined below), and costs were assessed for the 12-month post-switch period. Patients were "effectively treated" if they satisfied all six criteria for a treatment effectiveness algorithm (high adherence, no dose increase, no new conventional synthetic disease-modifying anti-rheumatic drug, no subsequent switch in therapy, no new/increased oral glucocorticoids, and <2 glucocorticoid injections). Multivariable logistic models were used to adjust for baseline factors.
The database included 581 new MOA switchers and 935 TNFi cyclers. New MOA switchers were 39% more likely than TNFi cyclers to persist after the switch (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.12-1.74; p = .003) and 36% less likely to switch therapy again (OR = 0.64; 95% CI = 0.51-0.81; p < .001). New MOA switchers were 43% more likely than TNFi cyclers to be effectively treated (OR = 1.43; 95% CI = 1.11-1.85; p = .006). New MOA switchers had 16% lower drug costs than TNFi cyclers (cost ratio = 0.84; 95% CI = 0.79-0.88; p < .001) and 11% lower total costs of rheumatoid arthritis-related medical care (cost ratio = 0.89; 95% CI = 0.84-0.94; p < .001).
Claims payments may not reflect rebates or other cost offsets. Medical and pharmacy claims do not include clinical end-points or reasons that lead to new MOA switching vs TNFi cycling.
These results support switching to a new MOA after a patient fails treatment with a TNFi, which is consistent with recent guidelines for the pharmacologic management of established rheumatoid arthritis.
研究类风湿性关节炎患者从肿瘤坏死因子抑制剂（TNFi）（阿达木单抗、聚乙二醇化赛妥珠单抗、依那西普、戈利木单抗或英夫利昔单抗）转换治疗方案后的治疗模式、治疗效果和治疗成本，转换方式包括循环使用另一种TNFi（“TNFi循环使用者”）或转换至新的作用机制（阿巴西普、托珠单抗或托法替布）（“新作用机制转换使用者”）。
这项回顾性队列研究使用了一家全国性保险公司的行政索赔数据。对转换治疗方案后12个月的治疗持续性（不再转换、重新开始或停药）、治疗效果（定义如下）和成本进行评估。如果患者满足治疗效果算法的所有六项标准（高依从性、未增加剂量、未使用新的传统合成抗风湿药物、后续未更换治疗方案、未使用新的/增加剂量的口服糖皮质激素以及<2次糖皮质激素注射），则被视为“有效治疗”。使用多变量逻辑模型对基线因素进行调整。
数据库包括581名新作用机制转换使用者和935名TNFi循环使用者。新作用机制转换使用者在转换后持续治疗的可能性比TNFi循环使用者高39%（优势比[OR]=1.39；95%置信区间[CI]=1.12-1.74；p=0.003）再次转换治疗方案的可能性低36%（OR=0.64；95%CI=0.51-0.
