Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands.
Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
Pharmacol Res Perspect. 2021 Aug;9(4):e00843. doi: 10.1002/prp2.843.
The aim of this study was to assess switching patterns and determinants for switching in patients initiating TNFα inhibitor (TNFα-i) treatment. Patients were included who started TNFα-i treatment between July 1, 2012 and December 31, 2017, from three Dutch hospitals, and were diagnosed with rheumatic diseases (RD), inflammatory bowel disease (IBD), or psoriasis. Outcomes were switching, defined as initiating another biological; switching patterns including multiple switches until the end of follow-up; determinants for first switch, assessed using multivariate logistic regression. A total of 2228 patients were included (median age 43.3 years, 57% female), of which 52% (n = 1155) received TNFα-i for RD, 43% (n = 967) for IBD, and 5% (n = 106) for psoriasis. About 16.6% of RD patients, 14.5% of IBD patients, and 16.0% of psoriasis patients switched at least once, mainly to another TNFα-i. TNFα-i dose escalation (OR 13.78, 95% CI 1.40-135.0) and high-dose corticosteroids initiation (OR 3.62, 95% CI 1.10-12.15) were determinants for switching in RD patients. TNFα-i dose escalation (OR 8.22, 95% CI 3.76-17.93), immunomodulator initiation/dose escalation (OR 2.13, 95% CI 1.04-4.34), high-dose corticosteroids initiation (OR 6.91, 95% CI 2.81-17.01) and serum concentration measurement (OR 5.44, 95% CI 2.74-10.79) were determinants for switching in IBD patients. Switching biological treatment occurred in about one in six patients. RD patients with TNFα-i dose escalation and/or high-dose corticosteroids initiation were more likely to switch. IBD patients with TNFα-i or immunomodulator initiation/dose escalation, high-dose corticosteroids initiation or serum concentration measurement were more likely to switch. These findings might help clinicians anticipating switching in TNFα-i treatment.
本研究旨在评估开始使用 TNFα 抑制剂 (TNFα-i) 治疗的患者的转换模式和转换决定因素。研究纳入了 2012 年 7 月 1 日至 2017 年 12 月 31 日期间在荷兰的三家医院接受治疗的风湿性疾病 (RD)、炎症性肠病 (IBD) 或银屑病患者。结局指标为转换,定义为开始使用另一种生物制剂;转换模式包括直至随访结束的多次转换;使用多变量逻辑回归评估首次转换的决定因素。共纳入 2228 例患者(中位年龄 43.3 岁,57%为女性),其中 52%(n=1155)接受 TNFα-i 治疗 RD,43%(n=967)治疗 IBD,5%(n=106)治疗银屑病。约 16.6%的 RD 患者、14.5%的 IBD 患者和 16.0%的银屑病患者至少转换了一次,主要是转为另一种 TNFα-i。RD 患者中 TNFα-i 剂量升级(OR 13.78,95%CI 1.40-135.0)和高剂量皮质类固醇起始(OR 3.62,95%CI 1.10-12.15)是转换的决定因素。TNFα-i 剂量升级(OR 8.22,95%CI 3.76-17.93)、免疫调节剂起始/剂量升级(OR 2.13,95%CI 1.04-4.34)、高剂量皮质类固醇起始(OR 6.91,95%CI 2.81-17.01)和血清浓度测量(OR 5.44,95%CI 2.74-10.79)是 IBD 患者转换的决定因素。大约每六名患者中就有一名转换生物治疗。TNFα-i 剂量升级和/或高剂量皮质类固醇起始的 RD 患者更有可能转换。TNFα-i 或免疫调节剂起始/剂量升级、高剂量皮质类固醇起始或血清浓度测量的 IBD 患者更有可能转换。这些发现可能有助于临床医生预测 TNFα-i 治疗中的转换。