Use of Anti-Tumor Necrosis Factor Therapy: A Retrospective Study of Monotherapy and Adherence to Combination Therapy with Non-Biologic Disease-Modifying Anti-Rheumatic DrugsReportar como inadecuado




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Rheumatology and Therapy

, Volume 2, Issue 2, pp 127–139

First Online: 25 August 2015Received: 12 May 2015

Abstract

IntroductionThis study examined the use of anti-tumor necrosis factor anti-TNF monotherapy, adherence with non-biologic disease-modifying anti-rheumatic drugs nbDMARDs in patients receiving a combination of anti-TNF therapies and nbDMARDs, and the impact of nbDMARD adherence on anti-TNF persistence among patients with rheumatoid arthritis RA.

MethodsPatients with RA aged ≥18 years from a US commercial health plan with claims for anti-TNFs 2006–2010 were defined as either biologic-naive or -exposed anti-TNF initiators based on previous nbDMARD use.
Adherence to nbDMARDs and anti-TNF persistence were estimated.
Cox regression estimated the association between nbDMARD adherence and anti-TNF persistence.

ResultsAmong 9764 patients identified mean age 50.2 years; 78% female, 55% of biologic-naive patients and 49% of previously exposed patients initiated any combination therapy during follow-up.
Among biologic-naive combination therapy patients, 53% adhered to nbDMARD therapy <80% of the time while receiving anti-TNF therapies; 33% had <60% adherence.
Compared with the most adherent patients, patients adherent to nbDMARDs 20% to 79% of the time were 30% to 20% more likely to discontinue their anti-TNF therapy in the period >90 days after starting the anti-TNF therapy.
This relationship was not observed for patients with nbDMARD adherence of <20% who were less likely to discontinue their anti-TNF therapy during the first 90 days of treatment.

ConclusionAlmost one-third of patients with RA receiving anti-TNF therapy received it as pure monotherapy.
About one-third of combination therapy recipients had <60% adherence to nbDMARDs.
Higher nbDMARD adherence may be associated with better anti-TNF persistence after an initial treatment period.

KeywordsAdherence Anti-TNF therapy Combination therapy Discontinuation DMARD Persistence Rheumatoid arthritis Electronic supplementary materialThe online version of this article doi:10.1007-s40744-015-0015-x contains supplementary material, which is available to authorized users.

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Autor: Nicole M. Engel-Nitz - Sarika Ogale - Mahesh Kulakodlu

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



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