Patel Aarti A, Ferrante Shannon Allen, Lin Iris, Fu Alex Z, Campbell Alicia K, Tieng Arlene
Janssen Scientific Affairs, LLC, Horsham, PA, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
Georgetown University Medical Center, Washington, DC, USA.
Rheumatol Ther. 2023 Oct;10(5):1241-1253. doi: 10.1007/s40744-023-00580-y. Epub 2023 Jul 15.
In patients with psoriatic arthritis (PsA), potential differences in care by race/ethnicity have not been well studied.
This retrospective, observational cohort analysis utilized the IBM MarketScan Multi-State Medicaid database. Patients aged ≥ 18 years with two or more PsA-related claims between January 1, 2010 and December 31, 2019, and ≥ 12 months of continuous enrollment before the first diagnosis of PsA (index date) were included. Outcomes evaluated were the use of disease-modifying antirheumatic drugs (DMARDs) overall and by type (conventional synthetic, biologic, targeted synthetic) within 12 months following initial PsA diagnosis, as well as the time to DMARD initiation after initial PsA diagnosis, stratified by race/ethnicity. Multivariate Cox proportional hazards models were used to assess potential associations between patient baseline characteristics and time to DMARD initiation.
Among patients with newly diagnosed PsA (N = 3432), the mean age was 44.4 years, 69.9% were female, 77.4% were White, and 10.1% were Black. Of the 2993 patients with at least 12 months of follow-up, fewer Black patients received any DMARD therapy compared with White patients (68.4 vs. 76.4%, respectively, p = 0.002), and, specifically, a lower percentage of Black patients received biologic DMARDs compared with White patients (33.6 vs. 42.6%, respectively, p = 0.003). After adjusting for baseline characteristics, Black patients had significantly longer time to initiation of any DMARD (HR [95% CI] 0.82 [0.71-0.94]) and biologic DMARD (0.84 [0.71-0.99]) compared with White patients. Other baseline variables such as older age, anxiety, and hepatitis C were also significantly associated with longer time to any DMARD initiation after initial PsA diagnosis.
Time to treatment initiation was significantly longer in Black patients compared with White patients with newly diagnosed PsA. These findings suggest care delivery disparities in patients with PsA and highlight the need for future studies to understand factors that drive the observed differences in drug therapy by race/ethnicity.
在银屑病关节炎（PsA）患者中，种族/民族在治疗方面的潜在差异尚未得到充分研究。
这项回顾性观察队列分析使用了IBM MarketScan多州医疗补助数据库。纳入年龄≥18岁、在2010年1月1日至2019年12月31日期间有两项或更多与PsA相关索赔且在首次诊断PsA（索引日期）前连续登记≥12个月的患者。评估的结果包括首次PsA诊断后12个月内疾病改善抗风湿药物（DMARDs）的总体使用情况及按类型（传统合成、生物、靶向合成）的使用情况，以及首次PsA诊断后开始使用DMARDs的时间，并按种族/民族进行分层。使用多变量Cox比例风险模型评估患者基线特征与开始使用DMARDs时间之间的潜在关联。
在新诊断的PsA患者（N = 3432）中，平均年龄为44.4岁，69.9%为女性，77.4%为白人，10.1%为黑人。在2993例至少随访12个月的患者中，与白人患者相比，接受任何DMARD治疗的黑人患者更少（分别为68.4%和76.4%，p = 0.002），具体而言，与白人患者相比，接受生物DMARDs的黑人患者比例更低（分别为33.6%和42.6%，p = 0.003）。在调整基线特征后，与白人患者相比，黑人患者开始使用任何DMARDs（HR [95% CI] 0.82 [0.71 - 0.94]）和生物DMARDs（0.84 [0.71 - 0.99]）的时间显著更长。其他基线变量，如年龄较大、焦虑和丙型肝炎，也与首次PsA诊断后开始使用任何DMARDs的时间显著相关。
与新诊断的PsA白人患者相比，黑人患者开始治疗的时间显著更长。这些发现表明PsA患者在医疗服务提供方面存在差异，并强调未来需要开展研究以了解导致观察到的种族/民族药物治疗差异的因素。
