Lumanity, Sheffield, UK.
Janssen-Cilag, High Wycombe, UK.
Adv Ther. 2024 May;41(5):2010-2027. doi: 10.1007/s12325-023-02766-w. Epub 2024 Mar 30.
For some immune-mediated disorders, despite the range of therapies available there is limited evidence on which treatment sequences are best for patients and healthcare systems. We investigated how their selection can impact outcomes in an Italian setting.
A 3-year state-transition treatment-sequencing model calculated potential effectiveness improvements and budget reallocation considerations associated with implementing optimal sequences in ankylosing spondylitis (AS), Crohn's disease (CD), non-radiographic axial spondyloarthritis (NR-AxSpA), plaque psoriasis (PsO), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ulcerative colitis (UC). Sequences included three biological or disease-modifying treatments, followed by best supportive care. Disease-specific response measures were selected on the basis of clinical relevance, data availability, and data quality. Efficacy was differentiated between biologic-naïve and experienced populations, where possible, using published network meta-analyses and real-world data. All possible treatment sequences, based on reimbursement as of December 2022 in Italy (analyses' base country), were simulated.
Sequences with the best outcomes consistently employed the most efficacious therapies earlier in the treatment pathway. Improvements to prescribing practice are possible in all diseases; however, most notable was UC, where the per-patient 3-year average treatment failure was 37.3% higher than optimal. The results focused on the three most crowded and prevalent immunological sub-condition diseases in dermatology, rheumatology, and gastroenterology: PsO, RA, and UC, respectively. By prescribing from within the top 20% of the most efficacious sequences, the model found a 15.1% reduction in treatment failures, with a 1.59% increase in drug costs.
Prescribing more efficacious treatments earlier provides a greater opportunity to improve patient outcomes and minimizes treatment failures.
对于一些免疫介导的疾病，尽管有多种治疗方法，但对于患者和医疗保健系统来说，哪种治疗方案最佳的证据有限。我们研究了在意大利环境下，这些方案的选择如何影响结果。
一个为期 3 年的状态转换治疗排序模型，用于计算与在强直性脊柱炎（AS）、克罗恩病（CD）、非放射性轴性脊柱关节炎（NR-AxSpA）、斑块型银屑病（PsO）、银屑病关节炎（PsA）、类风湿关节炎（RA）和溃疡性结肠炎（UC）中实施最佳方案相关的潜在有效性改进和预算重新分配考虑因素。方案包括三种生物制剂或疾病修正治疗药物，随后是最佳支持治疗。根据临床相关性、数据可用性和数据质量，选择了特定疾病的反应措施。在可能的情况下，使用已发表的网络荟萃分析和真实世界数据对生物制剂初治和经验丰富的人群进行了疗效区分。基于截至 2022 年 12 月意大利的报销情况（分析的基础国家），模拟了所有可能的治疗方案。
始终在治疗途径早期使用最有效的疗法的方案，结果更好。在所有疾病中都有可能改善处方实践；但在 UC 中最为显著，其患者 3 年平均治疗失败率比最佳方案高出 37.3%。结果主要集中在皮肤科、风湿病学和胃肠病学中最拥挤和最常见的三种免疫性亚条件疾病：银屑病、类风湿关节炎和溃疡性结肠炎。通过从最有效的方案中排名前 20%的方案中进行处方，模型发现治疗失败减少了 15.1%，药物成本增加了 1.59%。
尽早使用更有效的治疗方法提供了改善患者结局的更大机会，并最大限度地减少了治疗失败。
