靶向治疗的起始对银屑病关节炎相关治疗的使用及医疗保健消费的影响：一项对来自法国健康保险数据库（SNDS）的9793例患者的队列研究。

Impact of initiation of targeted therapy on the use of psoriatic arthritis-related treatments and healthcare consumption: a cohort study of 9793 patients from the French health insurance database (SNDS).

作者信息

Pina Vegas Laura, Iggui Siham, Sbidian Emilie, Claudepierre Pascal

机构信息

Service de Rhumatologie, Hôpital Henri Mondor, Créteil, Île-de-France, France.

EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, Île-de-France, France.

出版信息

RMD Open. 2024 Aug 7;10(3):e004631. doi: 10.1136/rmdopen-2024-004631.

DOI:10.1136/rmdopen-2024-004631

PMID:39117446

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11409354/

Abstract

OBJECTIVES

To assess the potential impact of targeted therapies for psoriatic arthritis (PsA) on symptomatic treatments (non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioid analgesics), methotrexate and mood disorder treatments and on hospitalisation and sick leave.

METHODS

Using the French health insurance database, this nationwide cohort study included adults with PsA who were new users (not in the year before the index date) of targeted therapies for ≥9 months during 2015-2021. Main endpoints were difference in proportion of users of associated treatments, hospitalisations and sick leaves between 3 and 9 months after and 6 months before targeted therapy initiation. Logistic regression models adjusted for sex, age, psoriasis, inflammatory bowel disease and Charlson Comorbidity Index compared the impact of biologics initiation (tumour necrosis factor inhibitor (TNFi)/interleukin 17 inhibitor (IL17i)/IL12/23i) on associated treatment discontinuation.

RESULTS

Among 9793 patients initiating targeted therapy for PsA (mean age: 51±13 years, 47% men), 62% initiated TNFi, 14% IL17i, 10% IL12/23i, 1% Janus kinase inhibitor, 12% phosphodiesterase-4 inhibitor. After treatment initiation, the proportion of treatment users was significantly reduced for NSAIDs (-15%), opioid analgesics (-9%), prednisone (-9%), methotrexate (-15%) and mood disorder treatments (-2%), along with decreased hospitalisations (-12%) and sick leaves (-4%). TNFi had a greater sparing effect on NSAIDs and prednisone use than IL17i (OR=1.04, 95% CI=1.01 to 1.07; 1.04, 1.02 to 1.06) and IL12/23i (1.07, 1.04 to 1.10; 1.06, 1.04 to 1.09). Odds of methotrexate discontinuation was reduced with TNFi versus IL17i (0.96, 0.94 to 0.98) and IL12/23i (0.94, 0.92 to 0.97).

CONCLUSIONS

Targeted therapy initiation for PsA reduced the use of associated treatment and healthcare, with TNFi having a slightly greater effect than IL17i and IL12/23i, except for methotrexate discontinuation.

摘要

目的

评估银屑病关节炎（PsA）靶向治疗对症状性治疗（非甾体抗炎药（NSAIDs）、皮质类固醇、阿片类镇痛药）、甲氨蝶呤和情绪障碍治疗以及住院和病假的潜在影响。

方法

利用法国健康保险数据库，这项全国性队列研究纳入了2015年至2021年期间新使用靶向治疗≥9个月的PsA成年患者（在索引日期前一年未使用过）。主要终点是靶向治疗开始后3至9个月与开始前6个月相比，相关治疗使用者比例、住院率和病假率的差异。调整了性别、年龄、银屑病、炎症性肠病和查尔森合并症指数的逻辑回归模型比较了生物制剂起始治疗（肿瘤坏死因子抑制剂（TNFi）/白细胞介素17抑制剂（IL17i）/IL12/23i）对相关治疗停药的影响。

结果

在9793例开始接受PsA靶向治疗的患者中（平均年龄：51±13岁，47%为男性），62%开始使用TNFi，14%使用IL17i，10%使用IL12/23i，1%使用 Janus激酶抑制剂，12%使用磷酸二酯酶-4抑制剂。治疗开始后，NSAIDs（-15%）、阿片类镇痛药（-9%）、泼尼松（-9%）、甲氨蝶呤（-15%）和情绪障碍治疗（-2%）的使用者比例显著降低，同时住院率（-12%）和病假率（-4%）也有所下降。与IL17i（OR=1.04，95%CI=1.01至1.07；1.04，1.02至1.06）和IL12/23i（1.07，1.04至1.10；1.06，1.04至1.09）相比，TNFi对NSAIDs和泼尼松使用的节省效果更大。与IL17i（0.96，0.94至0.98）和IL12/23i（0.94，0.92至0.97）相比，TNFi使甲氨蝶呤停药的几率降低。