Wilson Debbie L, Kollampare Shubha, Kwoh C Kent, Zhou Lili, Ashbeck Erin L, Sudano Dominick, Lupi Maria, Miller Andrew, Smith Kristy, Lo-Ciganic Wei-Hsuan
University of Florida, Gainesville.
University of Arizona, Tucson.
ACR Open Rheumatol. 2024 Jun;6(6):380-387. doi: 10.1002/acr2.11663. Epub 2024 Mar 13.
We aimed to estimate Coccidioides serologic screening rates before initiation of biologic disease-modifying antirheumatic drugs including tofacitinib (b/tsDMARDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and/or noninhaled corticosteroids.
This retrospective cohort study used 2011 to 2016 US Medicare claims data and included beneficiaries with rheumatic or autoimmune disease residing in regions within Arizona, California, and Texas endemic for Coccidioides spp. with ≥1 prescription for a b/tsDMARD, csDMARD, and/or noninhaled corticosteroid. We estimated prior-year serologic screening incidence before initiating b/tsDMARDs, csDMARD, and/or noninhaled corticosteroid.
During 2012 to 2016, 4,331 beneficiaries filled 64,049 prescriptions for b/tsDMARDs, csDMARDs, and noninhaled corticosteroids. Arizona's estimated screening rate was 20.1% (95% confidence interval [95% CI] 14.5-25.7) in the year before prescription initiation for b/tsDMARDs, 8.1% (95% CI 6.5-9.7) before csDMARDs, and 6.9% (95% CI: 5.6-8.2) before corticosteroids. Screening rates for b/tsDMARDs (2.8%, 95% CI 0.0-6.7), csDMARDs (1.0%, 95% CI 0.0-2.0), and corticosteroids (0.8%, 95% CI: 0.4-1.1) were negligible in California and undetected in Texas. Adjusted screening rate before prescription for b/tsDMARDs in Arizona increased from 14.5% (95% CI 7.5-21.5) in 2012 to 26.7% (95% CI 17.6-35.8) in 2016. Rheumatologists prescribing b/tsDMARDs in Arizona screened more than other providers (20.9% [95% CI 13.9-27.9] vs 12.9% [95% CI 5.9-20.0]).
Coccidioides serologic screening rates among Medicare beneficiaries with rheumatic/autoimmune diseases on b/tsDMARDs, csDMARDs, and noninhaled corticosteroids was low in Coccidioides spp.-US endemic regions between 2012 and 2016. Alignment of screening recommendations and clinical practice is needed.
我们旨在评估在开始使用包括托法替布在内的生物性改善病情抗风湿药物（b/tsDMARDs）、传统合成改善病情抗风湿药物（csDMARDs）和/或非吸入性糖皮质激素之前的球孢子菌血清学筛查率。
这项回顾性队列研究使用了2011年至2016年美国医疗保险理赔数据，纳入了居住在亚利桑那州、加利福尼亚州和得克萨斯州球孢子菌属地方流行区域内患有风湿性或自身免疫性疾病且至少有1张b/tsDMARD、csDMARD和/或非吸入性糖皮质激素处方的受益人。我们估计了开始使用b/tsDMARDs、csDMARD和/或非吸入性糖皮质激素之前上一年的血清学筛查发生率。
在2012年至2016年期间，4331名受益人开具了64049张b/tsDMARDs、csDMARDs和非吸入性糖皮质激素的处方。亚利桑那州在开始开具b/tsDMARDs处方前一年的估计筛查率为20.1%（95%置信区间[95%CI]14.5 - 25.7），在开始开具csDMARDs处方前为8.1%（95%CI 6.5 - 9.7），在开始使用糖皮质激素前为6.9%（95%CI：5.6 - 8.2）。在加利福尼亚州，b/tsDMARDs（2.8%，95%CI 0.0 - 6.7）、csDMARDs（1.0%，95%CI 0.0 - 2.0）和糖皮质激素（0.8%）的筛查率可忽略不计，在得克萨斯州未检测到。亚利桑那州在开具b/tsDMARDs处方前的调整后筛查率从2012年的14.5%（95%CI 7.5 - 21.5）增至2016年的26.7%（95%CI 17.6 - 35.8）。在亚利桑那州开具b/tsDMARDs的风湿病学家的筛查率高于其他医疗服务提供者（20.9%[95%CI 13.9 - 27.9]对12.9%[95%CI 5.9 - 20.0]）。
2012年至2016年期间，在美国球孢子菌属地方流行区域内，接受b/tsDMARDs、csDMARDs和非吸入性糖皮质激素治疗的患有风湿性/自身免疫性疾病的医疗保险受益人的球孢子菌血清学筛查率较低。需要使筛查建议与临床实践保持一致。
