Koo Bon San, Lim Yu-Cheol, Lee Min-Young, Jeon Ja-Young, Yoo Hyun-Jeong, Oh In-Sun, Shin Ju-Young, Kim Tae-Hwan
Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea.
Rheumatol Ther. 2021 Mar;8(1):347-359. doi: 10.1007/s40744-020-00274-9. Epub 2021 Jan 9.
Tumor necrosis factor inhibitors (TNFis) may be administered at a reduced dose to patients with ankylosing spondylitis (AS) for various reasons. However, in practice, there is insufficient evidence of how the dose reduction of TNFi is implemented and the amount of medical costs it reduces. In this study, we investigated treatment patterns among patients with AS who were administered various TNFis. The effect on medical costs related to AS was also investigated using Korea's insurance claims database.
From the insurance claims database of the Health Insurance Review & Assessment Service in South Korea, patients with AS newly treated with TNFis (etanercept, adalimumab, golimumab, and infliximab) between July 1, 2013, and June 30, 2016, were enrolled. Patients treated with the TNFis were followed up for 2 years. Treatment patterns (continuation and discontinuation of TNFi) and dose reduction (< 50% of recommended dose) in patients who continued treatment were analyzed and compared among the TNFi groups using the Chi-square test. Healthcare costs between the dose reduction and maintenance groups were compared using general linear modeling.
Of 1352 patients, 764 (56.51%) continued using TNFis for 2 years, and 17.8% of these were administered reduced doses. TNFi dose reduction was the most frequent in 36 (24.83%) patients using etanercept, followed by those using adalimumab (21.97%), golimumab (11.70%), and infliximab (11.98%) (p = 0.0028). For each TNFi group, the total healthcare cost significantly decreased, that is, by 24.85% for adalimumab, 31.80% for etanercept, 26.34% for golimumab, and 35.52% for infliximab (p < 0.0001).
TNFi dose reduction was identified in 17.8% of the patients with AS, and the patterns were different for each TNFi. Additionally, the dose reductions significantly reduced the medical costs associated with AS, that is, from 24.85 to 35.52% of the total medical expenditure.
由于各种原因，肿瘤坏死因子抑制剂（TNFis）可能会以较低剂量给予强直性脊柱炎（AS）患者。然而，在实际应用中，关于如何实施TNFis剂量降低以及它能降低多少医疗成本，证据并不充分。在本研究中，我们调查了接受各种TNFis治疗的AS患者的治疗模式。还利用韩国的保险理赔数据库研究了其对AS相关医疗成本的影响。
从韩国健康保险审查与评估服务机构的保险理赔数据库中，纳入了2013年7月1日至2016年6月30日期间开始新使用TNFis（依那西普、阿达木单抗、戈利木单抗和英夫利昔单抗）治疗的AS患者。接受TNFis治疗的患者随访2年。使用卡方检验分析并比较各TNFis组中继续治疗患者的治疗模式（TNFis的持续使用和停用）以及剂量降低情况（<推荐剂量的50%）。使用一般线性模型比较剂量降低组和维持组之间的医疗费用。
在1352例患者中，764例（56.51%）持续使用TNFis达2年，其中17.8%接受了剂量降低治疗。使用依那西普的36例（24.83%）患者中TNFis剂量降低最为频繁，其次是使用阿达木单抗的患者（21.97%）、戈利木单抗的患者（11.70%）和英夫利昔单抗的患者（11.98%）（p = 0.0028）。对于每个TNFis组，总医疗费用均显著降低，即阿达木单抗降低了24.85%，依那西普降低了31.80%，戈利木单抗降低了26.34%，英夫利昔单抗降低了35.52%（p < 0.0001）。
在17.8%的AS患者中发现了TNFis剂量降低情况，且每种TNFis的模式有所不同。此外，剂量降低显著降低了与AS相关的医疗成本，即占总医疗支出的24.85%至35.52%。
