Pardey Nicolas, Zeidler Jan, Nellenschulte Tim Fritz, Stahmeyer Jona T, Hoeper Kirsten, Witte Torsten
Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Str. 7, 30159, Hannover, Deutschland.
Arzneimittelversorgung, Mobil Krankenkasse, Hannover, Deutschland.
Z Rheumatol. 2023 Sep;82(7):573-579. doi: 10.1007/s00393-021-01086-0. Epub 2021 Sep 20.
With the introduction of biologics the treatment landscape for patients with rheumatoid arthritis (RA) has rapidly expanded; however, according to German and European treatment guidelines the use of biologic disease-modifying antirheumatic drugs (bDMARD) is only indicated after insufficient response under methotrexate (MTX) doses of at least 20 mg/week (first-line treatment). The aim of the study was to analyze the guideline compliance of MTX prescription in the outpatient sector prior to treatment with biologics.
Claims data from the AOK Lower Saxony from 2013 to 2016 were provided for all insured patients with a diagnosis of RA and bDMARD prescription during the study period. Within a patient-specific observational period of 180 days prior to the first bDMARD prescription, the maximum prescribed MTX dosage was examined.
Data from 90 incident and 315 prevalent RA patients were analyzed. A maximum MTX prescription of < 20 mg/week was observed in 60.0% of incident patients and in 67.0% of prevalent patients. Men had a higher mean MTX maximum dose (17.1 ± 4.8 mg) than women (14.9 ± 5.0 mg; p < 0.0001). Of the study population 29.6% received oral only prescriptions during the observational period. In 12.4% of patients a switch to parenteral administration was made.
Targeted use of the full spectrum of therapies provided prior to initiation of bDMARD treatment may contribute to cost-effective RA care. This study showed indications for potential deficits in outpatient MTX prescription practice and can raise awareness for efficient treatment.
随着生物制剂的引入，类风湿关节炎（RA）患者的治疗前景迅速扩大；然而，根据德国和欧洲的治疗指南，仅在甲氨蝶呤（MTX）剂量至少为20mg/周且疗效不佳（一线治疗）后，才建议使用生物改善病情抗风湿药（bDMARD）。本研究的目的是分析在使用生物制剂治疗之前门诊MTX处方的指南依从性。
提供了下萨克森州AOK 2013年至2016年期间所有确诊为RA并在研究期间开具bDMARD处方的参保患者的理赔数据。在首次开具bDMARD处方前180天的患者特定观察期内，检查MTX的最大处方剂量。
分析了90例初发RA患者和315例RA现患患者的数据。在60.0%的初发患者和67.0%的现患患者中观察到MTX最大处方量<20mg/周。男性的MTX平均最大剂量（17.1±4.8mg）高于女性（14.9±5.0mg；p<0.0001）。在研究人群中，29.6%在观察期内仅接受口服处方。12.4%的患者改为胃肠外给药。
在开始bDMARD治疗之前有针对性地使用所有可用的治疗方法可能有助于实现具有成本效益的RA护理。本研究显示了门诊MTX处方实践中可能存在的不足，并可提高对有效治疗的认识。
