Swedish Medical Center/Providence St. Joseph Health and the University of Washington, Seattle, WA, 98122, USA.
Amgen Inc., Thousand Oaks, CA, USA.
Arthritis Res Ther. 2021 Sep 8;23(1):236. doi: 10.1186/s13075-021-02599-4.
Understanding the evolving treatment patterns in patients with rheumatoid arthritis (RA) is important for rheumatologists to make the best practice decisions and optimize treatment. Here, we describe treatment patterns among patients newly initiated on biologic and/or nonbiologic RA therapy over time after enrollment in the US Corrona RA registry.
This was a retrospective, cohort study of adult patients with RA enrolled in the Corrona RA registry. Patients were included in this study if they initiated therapy with conventional synthetic disease-modifying antirheumatic drug (csDMARD) monotherapy, TNF inhibitor (TNFi) monotherapy, other (non-TNFi) biologic monotherapy, or combination therapy (index therapy); initiated therapy between January 1, 2004, and December 31, 2015 (index date), after enrollment in the Corrona RA registry; had at least 6 months of follow-up time after the index date; and had at least one follow-up visit. Time periods of interest were based on the year of index therapy initiation: 2004-2007, 2008-2011, and 2012-2015.
This study included 8027 patients. csDMARD monotherapy and TNFi + csDMARD combination therapy were the most common index therapies in the registry (39.9% and 44.9%, respectively, in the 2004-2007 period; 38.6% and 38.2%, respectively, in the 2008-2011 period; and 35.2% for both in the 2012-2015 period). At therapy initiation, a higher proportion of patients who initiated other biologics, whether as monotherapies (54.0%) or in combination with csDMARD (49.9%), had high disease activity than those who initiated csDMARD monotherapy (28.4%). For 2012-2015 vs 2004-2007 and 2008-2011 periods, persistence on a given therapy appeared to decrease for the TNFi monotherapy cohort (48.2% vs 64.3% and 52.4%) and other biologic monotherapy cohort (52.3% vs 71.4% and 54.5%) over 12 months; switching from one therapy to another was common in the Corrona RA registry.
Increased switching from one therapy to another and decreased time on a given therapy was observed in the Corrona RA registry in the 2012-2015 period. This observation is most likely due to the increased availability of additional treatment options and/or the change in clinical focus, particularly the emphasis on achievement of treat-to-target goals of remission or low disease activity along with more aggressive treatment.
了解类风湿关节炎 (RA) 患者不断变化的治疗模式对于风湿病医生做出最佳实践决策和优化治疗非常重要。在这里，我们描述了在美国 Corrona RA 注册中心登记的患者在接受生物制剂和/或非生物制剂 RA 治疗后随时间推移的新开始治疗模式。
这是一项回顾性队列研究，纳入了 Corrona RA 注册中心登记的成年 RA 患者。如果患者在登记 Corrona RA 注册中心后开始接受常规合成疾病修饰抗风湿药物 (csDMARD) 单药治疗、TNF 抑制剂 (TNFi) 单药治疗、其他 (非 TNFi) 生物单药治疗或联合治疗 (起始治疗)；起始治疗时间在 2004 年 1 月 1 日至 2015 年 12 月 31 日（起始日期）之间；在起始日期后至少有 6 个月的随访时间；并且至少有一次随访。感兴趣的时间段基于起始治疗的年份：2004-2007 年、2008-2011 年和 2012-2015 年。
本研究共纳入 8027 例患者。csDMARD 单药治疗和 TNFi + csDMARD 联合治疗是该注册中心最常见的起始治疗方法（2004-2007 年分别为 39.9%和 44.9%，2008-2011 年分别为 38.6%和 38.2%，2012-2015 年分别为 35.2%）。在起始治疗时，开始其他生物制剂治疗的患者（无论是单药治疗[54.0%]还是与 csDMARD 联合治疗[49.9%]），与开始 csDMARD 单药治疗的患者相比，疾病活动度较高（28.4%）。与 2004-2007 年和 2008-2011 年相比，2012-2015 年 TNFi 单药治疗队列（48.2%对 64.3%和 52.4%）和其他生物制剂单药治疗队列（52.3%对 71.4%和 54.5%）的患者在 12 个月内持续接受某种治疗的比例似乎有所下降；从一种治疗方法转换为另一种治疗方法在 Corrona RA 登记处很常见。
在 2012-2015 年期间，Corrona RA 登记处观察到从一种治疗方法转换为另一种治疗方法的增加和接受特定治疗的时间减少。这种观察结果很可能是由于更多治疗选择的可用性增加和/或临床重点的变化，特别是实现缓解或低疾病活动度的治疗目标以及更积极的治疗的重点。
