ABSTRACT
Psoriatic arthritis (PsA), which affects musculoskeletal structures, skin and nails, is a chronic inflammatory disease. The treatment of PsA has changed tremendously over the past decade owing to the improvement in early diagnosis and treatment strategies. TNF-α blockers, including adalimumab, etanercept, golimumab and infliximab, are representatives of a revolution in the treatment of PsA. Certolizumab (a new anti-TNF agent) and ustekinumab (a fully human monoclonal antibody against IL-12 and IL-23) are approved for the treatment of active PsA. In recent years, multiple small molecule drugs targeting Janus kinase/signal transducers and activators of transcription signaling pathway have been developed and applied to treat PsA in clinic. Developing better targeted drugs is an important research direction for the treatment of psA in the future.
ABSTRACT
OBJECTIVE: We aimed to investigate whether persistence rates of Tumor necrosis factor (TNF) blockers in the early period was affected by the change in reimbursement guideline of Rheumatoid Arthritis (RA) using Korean National Health Insurance (NHI) claims database. METHODS: We identified patients with a diagnosis code of RA between January 2007 to December 2009 and who were 16 years of age or older, in a Korean NHI claims database. A subgroup RA patients who had recently started TNF blockers with 6 months of washout period in June 2007 (n=40), June 2008 (n=60), January 2009 (n=52) and June 2009 (n=68) were selected to compare the 6 months persistence rate. Also, we analyzed a change in prescriptions of TNF blockers in patients with RA for each 6 month period between 2007 and 2009. RESULTS: The persistence rates of TNF blockers during 6 months in each group was not statistically significant (67.5%, 75.0%, 73.1%, and 79.4%, p=0.22). However, when we compared the frequency of new patients started on TNF blockers in June 2009 to those in the same months in 2008 and 2007; there was a tendency to increase. During change in TNF blocker prescriptions between 2007 and 2009, the overall utilization of TNF blockers increased. CONCLUSION: The persistence rate of TNF blockers in the early period was not affected by change of reimbursement guidelines of RA. However, long-term design and multivariate analysis will be needed to identify the impact of change in reimbursement guideline on the persistence of TNF blockers.
Subject(s)
Humans , Arthritis, Rheumatoid , Multivariate Analysis , National Health Programs , Prescriptions , Tumor Necrosis Factor-alphaABSTRACT
OBJECTIVE: To estimate drug persistency and the safety of TNF blocker in Korean patients with rheumatoid arthritis. METHODS: Data were extracted from medical records of rheumatoid arthritis patients who had treated with TNF blocker or are currently using TNF blocker at Hanyang University Hospital for Rheumatic Diseases from December 2000 to November 2009 (REtrospective study for Safety and Efficacy of Anti-RA treatment with biologiCs, RESEARCh). Comprehensive chart reviews were undertaken on all patients and data on drug usages and response of TNF blocker was collected at initiation, 3 months and the time of data collection. Persistency with treatment was examined using life-table analysis and multivariate Cox proportional hazard models were developed to examine potential predictors of discontinuation of TNF blocker. RESULTS: A total of 268 patients were enrolled in this retrospective study. Among them 180 patients were included in the analysis of drug persistency. The 1-year and 5-year drug persistency of TNF blocker was 74% and 46%, respectively. Concomitant use of methotrexate (hazard ratio 0.46, 95% CI 0.27-0.80) was associated with higher persistence. Comparing to etanercept, adalimumab is an independent risk factor for discontinuation (hazard ratio 2.63, 95% CI 1.43-4.84). CONCLUSION: Five-year drug persistency of TNF blocker was 46% and concomitant use of methotrexate is associated with higher persistence.