美国风湿病学会的风湿病信息系统（RISE）登记处的数据：美国风湿病学会实践中的结节病治疗。
Treatment of Sarcoidosis in US Rheumatology Practices: Data From the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) Registry.
机构信息
University of California, San Francisco.
University of Cincinnati, Cincinnati, Ohio.
出版信息
Arthritis Care Res (Hoboken). 2022 Mar;74(3):371-376. doi: 10.1002/acr.24496. Epub 2022 Jan 28.
OBJECTIVE
Sarcoidosis is often treated with glucocorticoids, although the use of biologics is growing. Prescribing patterns for biologics for patients with sarcoidosis in US rheumatology practices have never been examined. Given that there are no steroid-sparing US Food and Drug Administration-approved therapies for sarcoidosis, we sought to characterize the real-world treatment of sarcoidosis and to assess practice-level variation in prescribing patterns.
METHODS
We conducted an observational study of patients with sarcoidosis using data from the Rheumatology Informatics System for Effectiveness (RISE) registry (2014-2018). The RISE registry represents an estimated 32% of the US clinical rheumatology workforce. Adult patients with ≥2 codes for sarcoidosis ≥30 days apart were included. We examined sarcoidosis-specific medication use at any time during the study period. Data were analyzed at the practice level.
RESULTS
A total of 3,276 patients with sarcoidosis from 184 practices were included. Of those patients, 75.1% were women, with a mean age of 59.0 ± 12.5 years; 48.3% were White and 27.6% were Black. Overall, 59.3% of patients were prescribed glucocorticoids, and 24.7% received prolonged glucocorticoid therapy (≥10 mg/day for ≥90 days). In all, 12.1% received a biologic or targeted synthetic disease-modifying antirheumatic drug (tsDMARD), most commonly tumor necrosis factor inhibitors. There was wide practice-level variation among 31 practices with ≥30 patients with sarcoidosis; biologic use ranged from 15.6% to 69.2%. Infliximab represented the most common biologic prescribed.
CONCLUSION
In a large sample of US rheumatology practices, 12.1% of patients with sarcoidosis received biologics or tsDMARDs. We found high variability in biologic use across practices. The significant use of long-term glucocorticoids suggests unmet therapeutic needs in this patient population.
目的
结节病常采用糖皮质激素治疗，尽管生物制剂的应用正在增加。美国风湿病学会实践中结节病患者使用生物制剂的处方模式从未被研究过。鉴于没有美国食品和药物管理局批准的用于治疗结节病的类固醇节约疗法，我们试图描述结节病的真实世界治疗方法，并评估处方模式的实践水平差异。
方法
我们使用风湿病信息系统有效性（RISE）登记处（2014-2018 年）的数据，对结节病患者进行了一项观察性研究。RISE 登记处代表了美国临床风湿病学劳动力的估计 32%。≥2 次间隔≥30 天的结节病≥2 次编码的成年患者被纳入研究。我们在研究期间的任何时候检查结节病特异性药物的使用情况。数据分析在实践水平进行。
结果
共纳入 184 个实践中的 3276 例结节病患者。这些患者中，75.1%为女性，平均年龄 59.0±12.5 岁；48.3%为白人，27.6%为黑人。总体而言，59.3%的患者服用了糖皮质激素，24.7%的患者接受了长期糖皮质激素治疗（≥10mg/天，≥90 天）。共有 12.1%的患者接受了生物制剂或靶向合成疾病修正抗风湿药物（tsDMARD）治疗，最常见的是肿瘤坏死因子抑制剂。在 31 个有≥30 例结节病患者的实践中，存在广泛的实践水平差异；生物制剂的使用范围从 15.6%到 69.2%。英夫利昔单抗是最常用的生物制剂。
结论
在一项大型美国风湿病学实践样本中，12.1%的结节病患者接受了生物制剂或 tsDMARD 治疗。我们发现生物制剂的使用在实践中存在很大差异。长期使用糖皮质激素表明该患者人群存在未满足的治疗需求。
Zotero 插件