Role of comorbidities on therapeutic persistence of biological agents in rheumatoid arthritis: results from the RECord-linkage On Rheumatic Disease study on administrative healthcare databases

D'Amico, Maria Ester; Silvagni, Ettore; Carrara, Greta; Zanetti, Anna; Govoni, Marcello; Scirè, Carlo Alberto; Bortoluzzi, Alessandra

doi:10.1080/03009742.2020.1855365

Cited by 6 publications

(3 citation statements)

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“…Comorbidities can influence treatment adherence in rheumatic diseases ( 12 , 13 ), so we analyzed the MoA subpopulations for distribution of the reported comorbidities based on the database entries ( Table 4 ). Osteoarthritis (OA) was significantly more prominent in the JAKi subpopulation (36.5%) than in the TNFi subpopulation (23.0%, p<0.001) and IL-17i subpopulation (24.4%, p=0.007) ( Supplementary Table S3) .…”

Section: Resultsmentioning

confidence: 99%

Drug survival superiority of tumor necrosis factor inhibitors and interleukin-17 inhibitors over Janus kinase inhibitors and interleukin-12/23 inhibitors in German psoriatic arthritis outpatients: retrospective analysis of the RHADAR database

Strunz,

Englbrecht,

Risser

et al. 2024

Front. Immunol.

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ObjectiveTreatment options with disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis (PsA) have evolved over recent years. In addition to Janus kinase inhibitors (JAKi), four classes of biologic DMARDs (bDMARDs; interleukin [IL]-23 inhibitors [IL-23i], IL-12/23 inhibitors [IL-12/23i], tumor necrosis factor inhibitors [TNFi], and IL-17 inhibitors [IL-17i]) are currently approved for moderate to severe PsA treatment. There is minimal evidence of the persistence of these drugs among PsA outpatients in a real-world scenario during the period following the approval of JAKi. Therefore, we aimed to analyze the drug survival rates of biologic and JAKi therapies among German PsA outpatients during routine clinical care.MethodsWe retrospectively analyzed PsA patients with a new prescription for a biologic or JAKi in the RHADAR database between January 2015 and October 2023. Kaplan-Meier Curves and Cox regression modelling were used to compare drug survival rates.Results1352 new prescriptions with bDMARDs (IL-12/23i [n=50], IL-23i [n=31], TNFi [n=774], IL-17i [n=360]) or JAKi (n=137) were identified. The 5-year drug survival rate was 67.8% for IL-17i, 62.3% for TNFi, 53.3% for JAKi, and 46.0% for IL-12/23i. Discontinuation probabilities for JAKi and IL-12/23i were significantly higher compared with TNFi (JAKi hazard ratio [HR] 1.66, [95% CI 1.23–2.24], p=0.001; IL-12/23i HR 1.54, [95% CI 1.02–2.33], p=0.042) and IL-17i (JAKi HR 1.77, [95% CI 1.27–2.47], p=0.001; IL-12/23i HR 1.64, [95% CI 1.06–2.55], p=0.027). JAKi-treated patients had more severe disease and more osteoarthritis (OA) compared to TNFi and more OA compared to IL-17i. ConclusionGerman PsA outpatients might persist longer with TNFi and IL-17i compared with IL-12/23i or JAKi. For TNFi, differences in subgroup characteristics and comorbidities (OA) may have affected drug survival rates. For IL-17i, the longer drug survival might not only be related to less OA compared to JAKi and, therefore, might be affected by other factors.

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Section: Resultsmentioning

confidence: 99%

Drug survival superiority of tumor necrosis factor inhibitors and interleukin-17 inhibitors over Janus kinase inhibitors and interleukin-12/23 inhibitors in German psoriatic arthritis outpatients: retrospective analysis of the RHADAR database

Strunz,

Englbrecht,

Risser

et al. 2024

Front. Immunol.

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“…Older age (≥ 65) was associated with lower risk for treatment suspension, as previously described [ 45 – 47 ], while higher number of visits to the PCP and higher CCI score were both associated with a modestly increased risk for treatment suspension, both probably reflecting worse disease severity or higher disease burden [ 47 ]. Previous studies showed an association between comorbidities and CCI and the risk for treatment suspension [ 48 , 49 ]. However, in the current study, preliminary univariate analysis revealed no statistically significant differences in comorbidities between those who suspended treatment and those who did not; therefore, only CCI was included in the model.…”

Section: Discussionmentioning

confidence: 99%

Real-World Data of Adherence and Drug Survival of Biologics in Treatment-Naïve and Treatment-experienced Adult Patients with Rheumatoid Arthritis

et al. 2023

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Introduction Biologic disease-modifying anti-rheumatics drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) are important treatments for rheumatoid arthritis (RA). As more of these drugs become available, there is a greater need to assess their real-world adherence and drug survival. Methods Treatment-naïve and treatment-experienced patients with RA who initiated treatment with bDMARDs and tofactinib during 2015–2018 in a large Israeli health maintenance organization were included. Adherence and time to treatment suspension were recorded. Odds for adherence were estimated using a multivariable logistic regression model. Risk for treatment suspension was estimated using a mixed-effect Cox proportional hazard model. Results The analysis included 753 eligible patients (61.8% treatment-naïve) treated with 1287 treatment episodes (tofacitinib 24.2%, tocilizumab 17.5%, etanercept 16.0%, adalimumab 10.4%, abatacept 9.9%, rituximab 9.0%, golimumab 6.9%, certolizumab pegol 3.6%, infliximab 1.9%, and sarilumab 0.5%). Good adherence was measured for almost all drugs, yet over 50% of all treatment episodes were suspended. Older age was associated with reduced risk for treatment suspension while higher number of primary care visits and higher Charlson’s comorbidity score were associated with increased risk. Compared to etanercept, treatment with adalimumab, certolizumab, or rituximab was associated with increased risk for treatment suspension (HR 1.68 95% CI 1.27–2.22, HR 1.62 95% CI 1.00–2.60, and HR 2.72 95% CI 2.02–3.67, respectively). Conclusion Treatment choice primarily depends on disease activity and prognosis. Real-world data, showing differences in drug survival of bDMARDs and tsDMARD, can also be used in the variety of considerations when choosing treatment. Future studies could separate patients with RA into subgroups, which would also account for potential drug survival differences and enable personalized therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02607-w.

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“…About safety, the most relevant issues when using b/tsDMARDs are infections, herpes zoster (HZ) reactivation, major cardiovascular events, including venous thromboembolic events (VTE), and change in lipid levels [ 22 ]. All these factors play a key role in the choice of therapies for RA [ 40 , 41 ].…”

Section: Safety Of Drugsmentioning

confidence: 99%

Focus on Sex and Gender: What We Need to Know in the Management of Rheumatoid Arthritis

Maranini

Bortoluzzi

Silvagni

et al. 2022

JPM

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Rheumatoid arthritis (RA) is a chronic inflammatory disease, affecting mostly women with a female/male ratio of 3:1. It is characterized by symmetrical polyarthritis, leading to progressive joint damage. Sex differences have been reported in terms of disease course and characteristics, influencing patients reported outcome measures (PROMs) and pain perception, ultimately leading to male–female disparities in treatment response. Notwithstanding, sex and gender discrepancies are still under-reported in clinical trials. Therefore, there is a consistent need for a precise reference of sex and gender issues in RA studies to improve treat-to-target achievement. This narrative review explores the above-mentioned aspects of RA disease, discussing the latest core principles of RA recommendations, from safety issues to early arthritis concept and management, treat-to-target and difficult-to-treat notions, up to the most recent debate on vaccination. Our final purpose is to evaluate how sex and gender can impact current management guidelines and how this issue can be integrated for effective disease control.

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Role of comorbidities on therapeutic persistence of biological agents in rheumatoid arthritis: results from the RECord-linkage On Rheumatic Disease study on administrative healthcare databases

Abstract: List of ICD-9CM codes and exemption codes (EC) for comorbidities considered in the study.

Cited by 6 publications

References 36 publications

Drug survival superiority of tumor necrosis factor inhibitors and interleukin-17 inhibitors over Janus kinase inhibitors and interleukin-12/23 inhibitors in German psoriatic arthritis outpatients: retrospective analysis of the RHADAR database

Drug survival superiority of tumor necrosis factor inhibitors and interleukin-17 inhibitors over Janus kinase inhibitors and interleukin-12/23 inhibitors in German psoriatic arthritis outpatients: retrospective analysis of the RHADAR database

Real-World Data of Adherence and Drug Survival of Biologics in Treatment-Naïve and Treatment-experienced Adult Patients with Rheumatoid Arthritis

Focus on Sex and Gender: What We Need to Know in the Management of Rheumatoid Arthritis

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