A. Fisher, Research Associate, MD, PhD, C.R. Dormuth, Associate Professor, ScD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia;
M. Hudson, Associate Professor, MD, Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, Department of Medicine, McGill University, Montreal, Québec.
J Rheumatol. 2021 Jan 1;48(1):16-24. doi: 10.3899/jrheum.191252. Epub 2020 Oct 1.
To compare medication persistence of tofacitinib with persistence of injectable biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA).
We performed a retrospective new-user cohort study of patients with RA in the IBM MarketScan Research Databases. New users of tofacitinib or bDMARD were identified between November 2012 and December 2016. Persistence, in number of years, was the time between treatment initiation and the earliest occurrence of discontinuation or switching from the medication prescribed at cohort entry. Persistence of tofacitinib was compared with bDMARD persistence using Cox proportional hazards regression with adjustment for high-dimensional propensity scores. Similar methods were used for an analysis of post first-line therapy in patients who switched to tofacitinib from a bDMARD.
New tofacitinib users (n = 1031) were 56 years of age, on average, and 82% were women. New bDMARD users (n = 17,803) were 53 years of age, on average, and 78% were women. New tofacitinib users had shorter medication persistence (median 0.81 yrs) compared to bDMARD patients (1.02 yrs). After adjustment, the HR for discontinuation of tofacitinib compared with bDMARD was 1.14 (95% CI 1.05-1.25). Patients who switched to tofacitinib from a bDMARD had longer persistence than patients who switched to a bDMARD (adjusted HR for discontinuation 0.90, 95% CI 0.83-0.97).
Further research is warranted to understand the reasons for discontinuation of tofacitinib despite its ease of administration and to understand the observed differences between switchers and new users.
比较托法替布与注射用生物改善病情抗风湿药物（bDMARD）在类风湿关节炎（RA）患者中的药物维持率。
我们在 IBM MarketScan 研究数据库中进行了一项 RA 新使用者队列研究。在 2012 年 11 月至 2016 年 12 月期间，确定了托法替布或 bDMARD 的新使用者。维持率，以年数计，是从治疗开始到最早发生药物停用或从队列入组时开出处方药物的转换时间。使用调整高维倾向评分的 Cox 比例风险回归比较托法替布与 bDMARD 的维持率。对于从 bDMARD 转换为托法替布的患者的一线治疗后分析，使用了类似的方法。
新托法替布使用者（n=1031）的平均年龄为 56 岁，82%为女性。新 bDMARD 使用者（n=17803）的平均年龄为 53 岁，78%为女性。新托法替布使用者的药物维持时间较短（中位数 0.81 年），而 bDMARD 患者为 1.02 年。调整后，托法替布与 bDMARD 相比停药的 HR 为 1.14（95%CI 1.05-1.25）。与转换为 bDMARD 的患者相比，从 bDMARD 转换为托法替布的患者的维持时间更长（调整后的停药 HR 为 0.90，95%CI 0.83-0.97）。
需要进一步研究以了解尽管托法替布易于管理但仍停药的原因，并了解转换者和新使用者之间观察到的差异。
