Peasah Samuel K, Swart Elizabeth C S, Huang Yan, Kane-Gill Sandra L, Seybert Amy L, Patel Urvashi, Manolis Chronis, Good Chester B
Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA.
School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
Drugs Real World Outcomes. 2024 Jun;11(2):241-249. doi: 10.1007/s40801-024-00416-3. Epub 2024 Feb 18.
Disease-modifying anti-rheumatic drugs (DMARDs), since their introduction in 1990, have revolutionized the management of rheumatoid arthritis. Newer DMARDs have recently been approved, influencing treatment patterns and clinical guidelines.
To update the current prescribing patterns of DMARDs in the pharmacotherapy of rheumatoid arthritis (RA) to include the pandemic era.
This was a retrospective cross-sectional multi-year study. Using Optum's Clinformatics® Data Mart Database, we summarized trends in the prevalence of DMARD use in the USA from 2016 to 2021 by year for adult patients ≥ 18 years old with at least one medical RA claim and one pharmacy/medical claim of a DMARD medication. Trends included type of DMARD, class of DMARD (conventional (csDMARDs), biologics [tumor necrosis factor (TNFi) and Non-TNFi), and Janus kinase inhibitors (JAKs)], and triple therapy [methotrexate (MTX), hydroxychloroquine (HCQ), sulfasalazine (SUL)] used.
The total sample from 2016 to 2021 was 670,679 commercially insured patients. The average age was 63.7 years (SD 13.6), and 76.7% were female and 70% were White. csDMARDs remain the most prescribed (ranging from 77.2 to 79.2%). Although JAKs were the least prescribed DMARD class, their proportion more than doubled from 2016 (1.5%) to 2021 (4%). MTX utilization declined from 40% in 2016 to 34% in 2021. In contrast, HCQ use increased during the pandemic era from < 25% in 2018 to 30% in 2021. Although there is evidence of the therapeutic benefit of triple therapy, its use was very low (~ 1%) compared to biologics only (~ 17%) or biologics+MTX (~ 10%).
About half of patients with RA were on DMARDs. As expected, csDMARDs were highly used consistently. The COVID-19 pandemic might have influenced the use of HCQ and infusion DMARDs. Triple therapy use remains low.
自1990年引入以来，改善病情抗风湿药物（DMARDs）彻底改变了类风湿关节炎的治疗方式。最近有几种新型DMARDs获批，这对治疗模式和临床指南产生了影响。
更新类风湿关节炎（RA）药物治疗中DMARDs的当前处方模式，以纳入大流行时代的情况。
这是一项回顾性横断面多年研究。利用Optum的临床信息学数据集市数据库，我们总结了2016年至2021年美国≥18岁且至少有一项RA医疗索赔以及一项DMARD药物药房/医疗索赔的成年患者中DMARD使用流行率的年度趋势。趋势包括DMARD的类型、DMARD类别（传统药物（csDMARDs）、生物制剂[肿瘤坏死因子（TNFi）和非TNFi]以及Janus激酶抑制剂（JAKs）），以及三联疗法[甲氨蝶呤（MTX）、羟氯喹（HCQ）、柳氮磺胺吡啶（SUL）]的使用情况。
2016年至2~21年的总样本为670,679名商业保险患者。平均年龄为63.7岁（标准差13.6），76.7%为女性，70%为白人。csDMARDs仍然是处方最多的药物（占比77.2%至79.2%）。尽管JAKs是处方最少的DMARD类别，但其占比从2016年的1.5%到2021年增加了一倍多，达到4%。MTX的使用率从2016年的40%下降到2021年的34%。相比之下，HCQ的使用在大流行时代有所增加，从2018年的不到25%增至2021年的30%。尽管有证据表明三联疗法具有治疗益处，但其使用率非常低（约1%），而仅使用生物制剂的比例约为17%，使用生物制剂+MTX的比例约为10%。
约一半的RA患者使用DMARDs。正如预期的那样，csDMARDs一直被大量使用。2019冠状病毒病大流行可能影响了HCQ和注射用DMARDs的使用。三联疗法的使用率仍然很低。
