Naffaa Mohammad E, Hassan Fadi, Golan-Cohen Avivit, Merzon Eugene, Green Ilan, Saab Amir, Paz Ziv
Rheumatology Unit, Galilee Medical Center, Road 89, Naharyia, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel.
Rheumatol Int. 2021 Nov;41(11):1905-1913. doi: 10.1007/s00296-021-04989-y. Epub 2021 Sep 16.
Lack of sufficient head-to-head trials comparing biologic disease-modifying antirheumatic drugs (bDMARDs) in rheumatoid arthritis (RA), makes the choice of the first bDMARD a matter of rheumatologist's preference. Longer drug survival on the first bDMARD usually correlates with early remission. We aimed to identify factors associated with longer drug survival. We conducted a population-based retrospective longitudinal cohort study. We identified RA patients using the relevant International Classification of Disease 9th codes. "True" RA patients were defined as patients fulfilling, additionally, at least one of the following: receiving conventional DMARDs (cDMARDs), being positive for rheumatoid factor or anti-cyclic citrullinated peptide, or being diagnosed by a rheumatologist. We compared drug survival times and identified factors associated with longer drug survival. We identified 4268 true RA patients between the years of 2000-2017. 820 patients (19.2%) received at least one bDMARD. The most commonly prescribed bDMARDs were etanercept (352, 42.9%), adalimumab (143, 17.4%), infliximab (142, 17.3%) and tocilizumab (58, 7.1%). Infliximab was associated with the longest drug survival (47.1 months ± 46.3) while golimumab was associated with the shortest drug survival (14.9 months ± 15.1). Male gender [hazard ratio (HR) = 0.76, 95% confidence interval (CI), 0.63-0.86, p = 0.001], concurrent conventional DMARDs use (HR = 0.79, 95% CI 0.68 - 0.98, p = .031) and initiating bDMARD therapy in earlier calendric years (HR = 1.12, 95% CI 1.10 -1.18, p = 0.0001) were associated with longer drug survival. Male gender, concomitant cDMARDs and initiating biologic therapy at earlier calendric years are associated with longer drug survival.
由于缺乏足够的直接比较类风湿关节炎（RA）生物改善病情抗风湿药（bDMARDs）的头对头试验，因此选择首个bDMARD成为风湿科医生个人偏好的问题。首个bDMARD的较长药物生存期通常与早期缓解相关。我们旨在确定与较长药物生存期相关的因素。我们开展了一项基于人群的回顾性纵向队列研究。我们使用相关的国际疾病分类第9版编码来识别RA患者。“真正的”RA患者被定义为另外满足以下至少一项条件的患者：接受传统DMARDs（cDMARDs）治疗、类风湿因子或抗环瓜氨酸肽呈阳性，或由风湿科医生诊断。我们比较了药物生存期，并确定了与较长药物生存期相关的因素。我们在2000年至2017年期间识别出4268例真正的RA患者。820例患者（19.2%）接受了至少一种bDMARD。最常处方的bDMARDs是依那西普（352例，42.9%）、阿达木单抗（143例，17.4%）、英夫利昔单抗（142例，17.3%）和托珠单抗（58例，7.1%）。英夫利昔单抗与最长的药物生存期相关（47.1个月±46.3），而戈利木单抗与最短的药物生存期相关（14.9个月±15.1）。男性[风险比（HR）=0.76，95%置信区间（CI），0.63 - 0.86，p = 0.001]、同时使用传统DMARDs（HR = 0.79，95%CI 0.68 - 0.98，p = 0.031）以及在日历年份较早时开始bDMARD治疗（HR = 1.12，95%CI 1.10 - 1.18，p = 0.0001）与较长的药物生存期相关。男性、同时使用cDMARDs以及在日历年份较早时开始生物治疗与较长的药物生存期相关。
