Swedish Medical Center/Providence St Joseph Health and University of Washington, Seattle, WA, USA.
Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA, 98122, USA.
Adv Ther. 2024 Oct;41(10):3850-3867. doi: 10.1007/s12325-024-02904-y. Epub 2024 Aug 14.
Associations between increased functional disability and higher healthcare resource utilization (HCRU) and costs were reported in patients with psoriatic arthritis (PsA). We assessed characteristics/outcomes of patients with PsA receiving tofacitinib monotherapy vs combination therapy with conventional synthetic disease-modifying antirheumatic drugs.
Claims data from Optum Clinformatics Data Mart (OC) and Merative™ MarketScan (MS) databases between December 2017 and February 2020 were analyzed. Outcomes assessed were adherence/persistence by therapy type (monotherapy/combination therapy); HCRU/costs (per patient per month) by periods on-treatment (sum time on tofacitinib) and off-treatment (sum time off tofacitinib [gap of > 60 days]) plus therapy type.
This analysis included 274 and 395 tofacitinib-treated patients in OC (70.4% female, mean age 54.4 years) and MS (68.9% female, mean age 51.4 years), respectively. Percentages of patients with a proportion of days covered ≥ 0.8 at 12 months for monotherapy vs combination therapy were OC, 44.5% vs 53.8%; MS, 36.4% vs 45.7%. Generally similar trends were seen over 24 months and for medication possession ratio ≥ 0.8. Median (95% confidence interval) times to treatment discontinuation for monotherapy vs combination therapy were OC, 10.1 (7.4-11.8) vs 16.7 (8.3-26.6) months; MS, 6.9 (5.6-9.4) vs 11.0 (6.1-13.9) months. During off-treatment vs on-treatment periods, numerical decreases were observed for all-cause (OC, $5383 vs $6149; MS, $4145 vs $5180) and PsA-related costs (OC, $3237 vs $4515; MS, $2703 vs $3907) regardless of therapy type. During off-treatment vs on-treatment periods, numerical increases in outpatient visits for all-cause (OC, 2.37 vs 2.05; MS, 2.15 vs 1.99) and PsA-related visits (OC, 0.60 vs 0.46; MS, 0.47 vs 0.44) were observed, and PsA-related medications numerically decreased (OC, 1.21 vs 1.53; MS, 1.05 vs 1.48).
In this USA-based claims analysis, tofacitinib adherence was numerically lower for patients with PsA receiving monotherapy vs combination therapy. Costs numerically decreased off-treatment vs on-treatment, irrespective of therapy type, driven by lower medication costs.
关节炎患者的功能障碍增加与更高的医疗保健资源利用（HCRU）和成本相关。我们评估了接受托法替尼单药治疗与联合常规合成疾病修饰抗风湿药物（csDMARDs）治疗的关节炎患者的特征/结局。
分析了 Optum Clinformatics Data Mart（OC）和 Merative™ MarketScan（MS）数据库 2017 年 12 月至 2020 年 2 月期间的数据。根据治疗类型（单药治疗/联合治疗）评估了治疗期间的依从性/持久性；HCRU/成本（每位患者每月），治疗期间（托法替尼总治疗时间）和治疗结束期间（托法替尼停药超过 60 天的总时间[gap]）加治疗类型。
OC 中有 274 名接受托法替尼治疗的患者（70.4%为女性，平均年龄 54.4 岁）和 MS 中有 395 名接受托法替尼治疗的患者（68.9%为女性，平均年龄 51.4 岁）。12 个月时，单药治疗与联合治疗的覆盖率比例≥0.8 的患者比例分别为 OC 组的 44.5%和 53.8%；MS 组的 36.4%和 45.7%。在 24 个月和药物持有率≥0.8 时，也观察到类似的趋势。单药治疗与联合治疗的中位（95%置信区间）停药时间分别为 OC 组的 10.1（7.4-11.8）和 16.7（8.3-26.6）个月；MS 组的 6.9（5.6-9.4）和 11.0（6.1-13.9）个月。在治疗结束期间与治疗期间相比，无论治疗类型如何，所有原因（OC 组，$5383 与$6149；MS 组，$4145 与$5180）和关节炎相关成本（OC 组，$3237 与$4515；MS 组，$2703 与$3907）均呈数值下降。在治疗结束期间与治疗期间相比，所有原因（OC 组，2.37 与 2.05；MS 组，2.15 与 1.99）和关节炎相关就诊（OC 组，0.60 与 0.46；MS 组，0.47 与 0.44）的门诊就诊次数均呈数值增加，并且关节炎相关药物呈数值减少（OC 组，1.21 与 1.53；MS 组，1.05 与 1.48）。
在这项基于美国的索赔分析中，关节炎患者接受单药治疗与联合治疗的托法替尼依从性呈数值下降。无论治疗类型如何，治疗结束时的费用均呈数值下降，这主要是由于药物费用降低所致。
