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Arthritis Research and Therapy

, 19:159

First Online: 05 July 2017Received: 13 October 2016Accepted: 09 June 2017

Abstract

BackgroundBiologic disease-modifying antirheumatic drugs DMARDs are increasingly used for rheumatoid arthritis RA treatment. However, little is known based on contemporary data about the factors associated with DMARDs and patterns of use of biologic DMARDs for initial and subsequent RA treatment.

MethodsWe conducted an observational cohort study using claims data from a commercial health plan 2004–2013 and Medicaid 2000–2010 in three study groups: patients with early untreated RA who were naïve to any type of DMARD and patients with prevalent RA with or without prior exposure to one biologic DMARD. Multivariable logistic regression models were used to examine the effect of patient demographics, clinical characteristics and healthcare utilization factors on the initial and subsequent choice of biologic DMARDs for RA.

ResultsWe identified a total of 195,433 RA patients including 78,667 40% with early untreated RA and 93,534 48% and 23,232 12% with prevalent RA, without or with prior biologic DMARD treatment, respectively. Patients in the commercial insurance were 87% more likely to initiate a biologic DMARD versus patients in Medicaid OR = 1.87, 95% CI = 1.70–2.05. In Medicaid, African-Americans had lower odds of initiating OR = 0.59, 95% CI = 0.51–0.68 in early untreated RA; OR = 0.71, 95% CI = 0.61–0.74 in prevalent RA and switching OR = 0.71, 95% CI = 0.55–0.90 biologic DMARDs than non-Hispanic whites. Prior use of steroid and non-biologic DMARDs predicted both biologic DMARD initiation and subsequent switching. Etanercept, adalimumab, and infliximab were the most commonly used first-line and second-line biologic DMARDS; patients on anakinra and golimumab were most likely to be switched to other biologic DMARDS.

ConclusionsInsurance type, race, and previous use of steroids and non-biologic DMARDs were strongly associated with initial or subsequent treatment with biologic DMARDs.

KeywordsRheumatoid arthritis Antirheumatic agents Biologic therapy AbbreviationsACEAngiotensin-converting enzyme

ACRAmerican College of Rheumatology

ARBAngiotensin II receptor blockers

CIConfidence interval

COPDChronic obstructive pulmonary disease

CoxibsCyclooxygenase inhibitors

DMARDDisease-modifying antirheumatic drugs

FDAFood and Drug Administration

HCQHydroxychloroquine

ICD-9International Classification of Disease, Ninth Revision

MAXMedicaid Analytic eXtract

MTXMethotrexate

NSAIDSNon-selective non-steroidal anti-inflammatory drugs

OROdds ratio

RARheumatoid arthritis

TNFTumor necrosis factor

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Autor: Yinzhu Jin - Rishi J. Desai - Jun Liu - Nam-Kyong Choi - Seoyoung C. Kim

Fuente: https://link.springer.com/







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