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阿达木单抗患者支持项目的护理指导电话对加拿大克罗恩病患者临床结局的影响:一项观察性回顾性队列研究

Impact of Adalimumab Patient Support Program's Care Coach Calls on Clinical Outcomes in Patients with Crohn's Disease in Canada: An Observational Retrospective Cohort Study.

作者信息

Narula Neeraj, Millson Brad, Charland Katia, Donepudi Krishna, Gaetano Tania, McHugh Kevin, Latour Martin G, Gazel Sandra, Laliberté Marie-Claude, Marshall John K

机构信息

Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

IQVIA, Health Access and Outcomes Division, Kirkland, Quebec, Canada.

出版信息

J Can Assoc Gastroenterol. 2018 Dec;1(4):191-198. doi: 10.1093/jcag/gwy059. Epub 2018 Oct 15.

Abstract

BACKGROUND

Adalimumab is an antitumour necrosis factor (TNFα) biologic therapy indicated for the treatment of Crohn's disease (CD). Patients receiving adalimumab in Canada are eligible to enroll in the AbbVie Care™ patient support program (AC-PSP), which provides personalized services, including care coach calls (CCCs). The objective of this study was to compare the likelihood of achieving clinical remission in a cohort of CD patients treated with adalimumab who did and did not receive CCCs.

METHODS

A longitudinal analysis was performed using de-identified aggregate-level data collected through the AC-PSP. Patients were indexed on the date of their first injection of adalimumab between July 2010 and October 2014. The AC-PSP database included measurements of the Harvey-Bradshaw Index (HBI), a symptom-based measure of disease severity. Eligible patients had an initial HBI measurement performed between 90 days before and up to 30 days after the index date and a follow-up HBI measurement six to 18 months later. Adjusted relative risk (RR) of achieving remission (HBI ≤ 4) at the time of the follow-up was estimated comparing patients who received and did not receive CCCs.

RESULTS

There were 381 CD patients who met eligibility criteria; 224 (59%) received CCCs, and 157 (41%) did not receive CCCs. Multivariate regression analysis demonstrated that CD patients receiving CCCs had a 17% increased likelihood of achieving HBI remission when compared with patients who did not receive CCCs (RR = 1.17; 95% CI, 1.03-1.34; P = 0.0192).

CONCLUSIONS

This study provides preliminary evidence that a phone call intervention, aiming to improve the overall patient experience with adalimumab treatment, may increase the likelihood of HBI remission in patients taking adalimumab to manage CD.

摘要

背景

阿达木单抗是一种抗肿瘤坏死因子(TNFα)生物疗法,用于治疗克罗恩病(CD)。在加拿大接受阿达木单抗治疗的患者有资格参加艾伯维关爱™患者支持项目(AC - PSP),该项目提供个性化服务,包括护理指导电话(CCC)。本研究的目的是比较在接受和未接受CCC的阿达木单抗治疗的CD患者队列中实现临床缓解的可能性。

方法

使用通过AC - PSP收集的去识别化汇总数据进行纵向分析。患者在2010年7月至2014年10月期间首次注射阿达木单抗的日期被编入索引。AC - PSP数据库包括哈维 - 布拉德肖指数(HBI)的测量值,这是一种基于症状的疾病严重程度测量方法。符合条件的患者在索引日期前90天至索引日期后30天内进行了初始HBI测量,并在6至18个月后进行了随访HBI测量。通过比较接受和未接受CCC的患者,估计随访时达到缓解(HBI≤4)的调整相对风险(RR)。

结果

有381名CD患者符合资格标准;224名(59%)接受了CCC,157名(41%)未接受CCC。多变量回归分析表明,与未接受CCC的患者相比,接受CCC的CD患者实现HBI缓解的可能性增加了17%(RR = 1.17;95% CI,1.03 - 1.34;P = 0.0192)。

结论

本研究提供了初步证据,即旨在改善患者使用阿达木单抗治疗总体体验的电话干预可能会增加服用阿达木单抗治疗CD的患者实现HBI缓解的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5ac/6542296/7b518f5427b7/gwy05901.jpg

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