Husni M Elaine, Chang Eunice, Broder Michael S, Paydar Caleb, Bognar Katalin, Desai Pooja, Klyachkin Yuri, Khilfeh Ibrahim
Cleveland Clinic, Cleveland, OH, USA.
Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA.
Open Access Rheumatol. 2022 Jun 15;14:123-132. doi: 10.2147/OARRR.S342123. eCollection 2022.
To compare the rate of biologic initiation after commencing treatment with apremilast (APR) vs methotrexate (MTX), in systemic-naïve patients with psoriatic arthritis (PsA).
Systemic-naïve patients with PsA who started treatment with either APR or MTX between 01/01/2015 and 12/31/2018 were analyzed using claims data from the IBM MarketScan Commercial and Medicare Supplemental databases (2014-2019). PsA patients were identified via diagnosis codes; the first prescription date for APR or MTX was the index date. Patient demographics, clinical characteristics, healthcare utilization during the year pre-index (baseline) and the year post-index (follow-up), and median time to biologic initiation were reported descriptively. The rates and risk of biologic initiation during follow-up were compared between APR and MTX users by logistic and Cox regressions, respectively. Models were adjusted for demographics, clinical and utilization measures during the baseline period.
A total of 2116 patients with PsA newly treated with APR (n = 534) or MTX (n = 1582) were identified. Mean age was similar (50.5 vs 50.4; = 0.938), and proportion of females was higher for APR vs MTX users (59.4% vs 54.0%; = 0.031). Mean time to biologic initiation among patients who initiated during follow-up was 194.1 vs 138.7 days between APR vs MTX users ( < 0.001). After adjusting for confounders, the likelihood of biologic initiation was 58% lower (OR, 0.42 [95% CI, 0.32-0.54]; < 0.001) with APR, with a significantly lower predicted rate of biologic initiation among APR users when compared to MTX users during follow-up (20.0% [95% CI, 16.6-23.9%] vs 37.5% [95% CI, 35.0-40.1%]). Additionally, APR users had a lower risk of biologic initiation than MTX users (HR, 0.46 [95% CI, 0.37-0.57]; < 0.001) during the 1-year follow-up.
Systemic-naïve patients with PsA have a lower rate of, and longer time to, biologic initiation over one-year following APR initiation, compared to those initiating MTX.
比较初治的银屑病关节炎（PsA）患者开始使用阿普米司特（APR）与甲氨蝶呤（MTX）治疗后启动生物制剂治疗的比例。
利用IBM MarketScan商业数据库和医疗保险补充数据库（2014 - 2019年）中的理赔数据，对2015年1月1日至2018年12月31日期间开始使用APR或MTX治疗的初治PsA患者进行分析。通过诊断编码识别PsA患者；APR或MTX的首个处方日期为索引日期。对患者的人口统计学特征、临床特征、索引前一年（基线）和索引后一年（随访）的医疗利用情况以及启动生物制剂治疗的中位时间进行描述性报告。分别通过逻辑回归和Cox回归比较APR和MTX使用者在随访期间启动生物制剂治疗的比例和风险。模型针对基线期的人口统计学、临床和利用指标进行了调整。
共识别出2116例新接受APR（n = 534）或MTX（n = 1582）治疗的PsA患者。平均年龄相似（50.5岁对50.4岁；P = 0.938），APR使用者的女性比例高于MTX使用者（59.4%对54.0%；P = 0.031）。随访期间开始治疗的患者中，APR使用者与MTX使用者启动生物制剂治疗的平均时间分别为194.1天和138.7天（P < 0.001）。在调整混杂因素后，使用APR启动生物制剂治疗的可能性降低了58%（比值比，0.42 [95%置信区间，0.32 - 0.54]；P < 0.001），与MTX使用者相比，APR使用者在随访期间启动生物制剂治疗的预测比例显著更低（20.0% [95%置信区间，16.6 - 23.9%]对37.5% [95%置信区间，35.0 - 40.1%]）。此外，在1年的随访期间，APR使用者启动生物制剂治疗的风险低于MTX使用者（风险比，0.46 [95%置信区间，0.37 - 0.57]；P < 0.001）。
与开始使用MTX治疗的初治PsA患者相比，开始使用APR治疗的患者在1年随访期间启动生物制剂治疗的比例更低，时间更长。
