Wilke Thomas, Mueller Sabrina, Lee Sze Chim, Majer Istvan, Heisen Marieke
IPAM, University of Wismar, Alter Holzhafen 19, 23966, Wismar, Germany.
Ingress-health, Alter Holzhafen 19, 23966, Wismar, Germany.
BMC Musculoskelet Disord. 2017 Aug 2;18(1):332. doi: 10.1186/s12891-017-1684-0.
Since persistence to first biological disease modifying anti-rheumatic drugs (bDMARDs) is far from ideal in rheumatoid arthritis (RA) patients, many do receive a second and/or third bDMARD treatment. However, little is known about treatment persistence of the second-line bDMARD and it is specifically unknown whether the mode of action of such a treatment is associated with different persistence rates. We aimed to assess discontinuation-, re-initiation- or continuation-rates of a 2nd bDMARD therapy as well as switching-rates to a third biological DMARD (3rd bDMARD) therapy in RA patients.
Analysis was based on German claims data (2010-2013). Patients were included if they had received at least one prescription for an anti-TNF and at least one follow-up prescription of a 2nd bDMARD different from the first anti-TNF. Patient follow-up started on the date of the first prescription for the 2nd bDMARD and lasted for 12 months or until a patient's death.
2667 RA patients received at least one anti-TNF prescription. Of these, 451 patients received a second bDMARD (340 anti-TNF, mean age 52.6 years; 111 non-anti-TNF, mean age 55.9 years). During the follow-up, 28.8% vs. 11.7% of the 2nd anti-TNF vs. non-anti-TNF patients (p < 0.001) switched to a 3rd bDMARD; 14.1% vs. 19.8% (p = 0.179) discontinued without re-start; 3.8% vs.1.8% (p = 0.387) re-started and 53.5 vs. 66.7% (p < 0.050) continued therapy. Patients in the non-anti-TNF group demonstrated longer drug survival (295 days) than patients in the anti-TNF group (264 days; p = 0.016). Independent variables associated with earlier discontinuation (including re-start) or switch were prescription of an anti-TNF as 2nd bDMARD (HR = 1.512) and a higher comorbidity level (CCI, HR = 1.112), whereas previous painkiller medication (HR = 0.629) was associated with later discontinuation or switch.
Only 56.8% of RA patients continued 2nd bDMARD treatment after 12 months; 60% if re-start was included. Non-anti-TNF patients had a higher probability of continuing 2nd bDMARD therapy.
由于类风湿关节炎（RA）患者对第一种生物疾病改善抗风湿药物（bDMARDs）的持续用药情况远不理想，许多患者确实接受了第二种和/或第三种bDMARD治疗。然而，关于二线bDMARD的治疗持续性知之甚少，具体而言，这种治疗的作用方式是否与不同的持续率相关尚不清楚。我们旨在评估RA患者二线bDMARD治疗的停药率、重新开始治疗率或继续治疗率，以及转换至第三种生物DMARD（3rd bDMARD）治疗的转换率。
分析基于德国医保数据（2010 - 2013年）。纳入的患者需满足至少接受过一次抗TNF药物处方，且至少有一次与第一种抗TNF不同的二线bDMARD的后续处方。患者随访从二线bDMARD的第一张处方日期开始，持续12个月或直至患者死亡。
2667例RA患者至少接受过一次抗TNF处方。其中，451例患者接受了第二种bDMARD（340例抗TNF，平均年龄52.6岁；111例非抗TNF，平均年龄55.9岁）。在随访期间，二线抗TNF患者与非抗TNF患者中分别有28.8%和11.7%（p < 0.001）转换至第三种bDMARD；分别有14.1%和19.8%（p = 0.179）停药且未重新开始治疗；分别有3.8%和1.8%（p = 0.387）重新开始治疗，以及53.5%和66.7%（p < 0.050）继续治疗。非抗TNF组患者的药物存活时间（295天）长于抗TNF组患者（264天；p = 0.016）。与较早停药（包括重新开始）或转换相关的独立变量包括二线bDMARD为抗TNF药物的处方（HR = 1.512）和更高的合并症水平（CCI，HR = 1.112），而之前使用止痛药（HR = 0.629）与较晚停药或转换相关。
12个月后，仅56.8%的RA患者继续二线bDMARD治疗；若包括重新开始治疗，则为60%。非抗TNF患者继续二线bDMARD治疗的可能性更高。
