Division of Rheumatology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers.
Division of Epidemiology, Department of Internal Medicine, Salt Lake City Veterans Affairs and University of Utah Medical Centers.
J Manag Care Spec Pharm. 2019 Nov;25(11):1218-1228. doi: 10.18553/jmcp.2019.25.11.1218.
Delays in treatment for inflammatory arthritis (IA) are associated with unfavorable outcomes, including impaired quality of life, irreversible joint damage, and disability.
To characterize treatment initiation patterns in veterans with newly diagnosed rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS).
ICD-9/10-CM codes and natural language processing were used to identify incident cases of RA, PsA, or AS between January 1, 2007, and December 31, 2015, in patients enrolled in the Veterans Health Administration. Patterns of treatment initiation and nontreatment with disease-modifying antirheumatic drugs (DMARDs) were assessed in the 12-month follow-up period after the incident diagnosis. Outcomes included the percentage of veterans treated with a DMARD, the mean time to the initial DMARD after diagnosis, and the percentage of veterans who accessed rheumatology care before DMARD initiation. To assess outcomes over time, veterans were grouped by year of initial IA diagnosis. Additionally, outcomes were compared between nonbiologic and biologic DMARDs and among IA subtypes (RA, PsA, and AS). Groups were statistically compared with 95% confidence intervals.
The population consisted of 12,118 IA veterans (9,711 RA, 1,472 PsA, and 935 AS), with 91.3% males and a mean age of 63.7 years. The percentage of veterans treated with ≥ 1 DMARD (nonbiologic or biologic) during the 12-month follow-up period increased from 48.8% in 2007 to 66.4% in 2015. In veterans diagnosed with IA in 2015, DMARD treatment was more common for PsA patients (72.9%) and RA patients (68.6%) than for AS patients (28.9%). In the subset treated with a DMARD within 12 months after diagnosis, the mean time to the initial DMARD after diagnosis did not change throughout the observation period (35.5 days for RA, 43.9 days for PsA, and 59.5 days for AS). Rheumatology specialty care was accessed by 87.4% of veterans treated with a nonbiologic DMARD and 92.2% of veterans treated with a biologic DMARD, in patients diagnosed in 2015.
DMARD treatment rates during the initial 12 months after diagnosis increased between 2007 and 2015, but nontreatment remained common, particularly in veterans with AS. The time to treatment after diagnosis was stable over time; it was shortest for RA, intermediate for PsA, and longest for AS. DMARD treatment was uncommon in veterans who did not access rheumatology specialty care.
AbbVie Pharmaceuticals and Marriott Daughters Foundation funded this study via investigator-initiated grants. Data analyses were completed by investigators independent of AbbVie and Marriott Daughters Foundation. Walker, Clewell, and Douglas are employed by, and stockholders in, Abbvie. Halwani reports grants from BMS, Kyowa Hakko Kirin, Seattle Genetics, Roche-Genentech, Miragen, Immunedesign, Takeda, Amgen, Pharmacyclics, and Abbvie. The other authors have nothing to disclose.
炎症性关节炎（IA）治疗的延迟与不良结局有关，包括生活质量受损、不可逆转的关节损伤和残疾。
描述新诊断类风湿关节炎（RA）、银屑病关节炎（PsA）或强直性脊柱炎（AS）退伍军人的治疗起始模式。
使用 ICD-9/10-CM 代码和自然语言处理，在退伍军人健康管理局登记的患者中，确定 2007 年 1 月 1 日至 2015 年 12 月 31 日期间新确诊的 RA、PsA 或 AS 病例。在确诊后 12 个月的随访期间，评估治疗起始和未治疗疾病修饰抗风湿药物（DMARDs）的模式。结果包括接受 DMARD 治疗的退伍军人的百分比、诊断后初始 DMARD 的平均时间以及在开始 DMARD 前接受风湿病学治疗的退伍军人的百分比。为了评估随时间变化的结果，根据初始 IA 诊断的年份将退伍军人分为不同组。此外，还比较了非生物和生物 DMARD 之间以及 IA 亚型（RA、PsA 和 AS）之间的结果。使用 95%置信区间对组进行了统计学比较。
该人群包括 12118 名 IA 退伍军人（9711 名 RA、1472 名 PsA 和 935 名 AS），其中 91.3%为男性，平均年龄为 63.7 岁。在 12 个月的随访期间，接受≥1 种 DMARD（非生物或生物）治疗的退伍军人百分比从 2007 年的 48.8%增加到 2015 年的 66.4%。在 2015 年确诊为 IA 的退伍军人中，与 AS 患者（28.9%）相比，PsA 患者（72.9%）和 RA 患者（68.6%）接受 DMARD 治疗更为常见。在确诊后 12 个月内接受 DMARD 治疗的亚组中，诊断后初始 DMARD 的平均时间在整个观察期间没有变化（RA 为 35.5 天，PsA 为 43.9 天，AS 为 59.5 天）。在 2015 年确诊的患者中，接受非生物 DMARD 治疗的 87.4%和接受生物 DMARD 治疗的 92.2%的退伍军人接受了风湿病学专科治疗。
2007 年至 2015 年间，诊断后最初 12 个月内 DMARD 治疗率有所增加，但治疗仍不常见，尤其是在 AS 退伍军人中。从诊断到治疗的时间相对稳定；RA 最短，PsA 居中，AS 最长。未接受风湿病学专科治疗的退伍军人 DMARD 治疗率较低。
AbbVie 制药公司和万豪女儿基金会通过资助者发起的赠款资助了这项研究。数据分析由 AbbVie 和万豪女儿基金会独立的研究人员完成。Walker、Clewell 和 Douglas 受雇于 AbbVie，是 AbbVie 的股东。Halwani 报告说，他收到了 BMS、Kyowa Hakko Kirin、Roche-Genentech、Miragen、Immunedesign、Takeda、Amgen、Pharmacyclics 和 Abbvie 的资助。其他作者没有任何利益冲突。
