Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, 619 19th Street South, 176F Rm 10250, Birmingham, AL, 35249, USA.
The Ohio State University and James Cancer Center, M210 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH, 43210, USA.
Adv Ther. 2022 Jan;39(1):328-345. doi: 10.1007/s12325-021-01959-5. Epub 2021 Nov 2.
We aimed to characterize real-world utilization of poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi) in women with ovarian cancer (OC).
This retrospective observational study of claims data from US MarketScan Commercial/Medicare Supplemental databases included women with OC initiating olaparib, niraparib, or rucaparib from January 1, 2017, to May 31, 2019. Patients were observed from first outpatient prescription until at least 30 days' follow-up. Clinical events of interest (CEIs), based on adverse reactions in PARPi prescribing information, were identified from claims using ICD-9/10 codes. Other outcomes included dose modification, persistence, adherence, healthcare resource utilization (HCRU), and cost.
Overall, 303, 348, and 162 women with OC received olaparib, niraparib, and rucaparib, respectively. During follow-up, risk of any CEI was higher with niraparib versus olaparib (odds ratio 3.36 [95% confidence interval 2.00-5.65]) and niraparib versus rucaparib (2.09 [1.10-3.95]), with no significant difference between rucaparib and olaparib (1.61 [0.93-2.79]). PARPi dose decreases were observed in 21.1%, 35.1%, and 30.2% of olaparib-, niraparib-, and rucaparib-treated patients, respectively. Persistence (no treatment gaps of more than 90 days) was significantly higher (P < 0.05) with olaparib (62.2%) versus niraparib (35.9%) and rucaparib (48.7%); adherence (medication possession ratio, MPR ≥ 80%) was 80.2% versus 38.6% and 63.2%, respectively (P < 0.001). Inpatient admissions and outpatient service use were higher with niraparib and rucaparib versus olaparib, reflected in mean (± standard deviation) total medical costs (excluding pharmacy) of $5393 ± 8828 for olaparib, $7732 ± 14,054 for niraparib, and $6868 ± 7929 for rucaparib.
Differences between the licensed PARPi were observed in the risk of experiencing a CEI, likelihood of dose modifications, ability to receive continuous PARPi therapy, HCRU, and costs.
本研究旨在描述卵巢癌（OC）女性中聚（ADP-核糖）聚合酶（PARP）抑制剂（PARPi）的真实世界应用情况。
本回顾性观察性研究利用美国 MarketScan 商业/医疗保险补充数据库中的理赔数据，纳入 2017 年 1 月 1 日至 2019 年 5 月 31 日期间起始使用奥拉帕利、尼拉帕利或鲁卡帕利的 OC 女性患者。患者从首次门诊处方开始观察，直至至少 30 天随访。基于 PARPi 说明书中的不良反应，从理赔中使用 ICD-9/10 代码确定了感兴趣的临床事件（CEI）。其他结局包括剂量调整、持续治疗、依从性、医疗资源利用（HCRU）和成本。
总体而言，分别有 303、348 和 162 名 OC 女性接受了奥拉帕利、尼拉帕利和鲁卡帕利治疗。在随访期间，尼拉帕利的任何 CEI 风险均高于奥拉帕利（比值比 3.36 [95%置信区间 2.00-5.65]）和鲁卡帕利（2.09 [1.10-3.95]），而鲁卡帕利与奥拉帕利之间无显著差异（1.61 [0.93-2.79]）。奥拉帕利、尼拉帕利和鲁卡帕利治疗患者的 PARPi 剂量减少率分别为 21.1%、35.1%和 30.2%。与尼拉帕利（35.9%）和鲁卡帕利（48.7%）相比，奥拉帕利的持续治疗率（无超过 90 天的治疗中断）显著更高（P<0.05）（62.2%）；与尼拉帕利（38.6%）和鲁卡帕利（63.2%）相比，奥拉帕利的依从性（用药比例，MPR≥80%）更高（80.2%）（P<0.001）。与奥拉帕利相比，尼拉帕利和鲁卡帕利的住院和门诊服务使用量更高，这反映在不含药房费用的总医疗费用（平均值±标准差）上，奥拉帕利为 5393 美元±8828 美元，尼拉帕利为 7732 美元±14054 美元，鲁卡帕利为 6868 美元±7929 美元。
在发生 CEI 的风险、剂量调整的可能性、持续 PARPi 治疗的能力、HCRU 和成本方面，已获批的 PARPi 之间存在差异。
