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Comparative effecti...
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Frisell, ThomasKarolinska Institutet,Karolinska Institute
(author)
Comparative effectiveness of abatacept, rituximab, tocilizumab and TNFi biologics in RA : Results from the nationwide Swedish register
- Article/chapterEnglish2019
Publisher, publication year, extent ...
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2019-01-21
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Oxford University Press (OUP),2019
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11 s.
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LIBRIS-ID:oai:lup.lub.lu.se:aed6dab2-3c01-4dcc-be0b-b122170bb316
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https://lup.lub.lu.se/record/aed6dab2-3c01-4dcc-be0b-b122170bb316URI
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https://doi.org/10.1093/rheumatology/key433DOI
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https://gup.ub.gu.se/publication/286000URI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:142177964URI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
Notes
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Objectives: Current guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as having equal effectiveness for the treatment of RA, at least as second line therapies. These recommendations are mainly based on meta-analysis of randomized controlled trials, with few direct drug-drug comparisons. Our objective was to compare the real-world absolute and relative effectiveness among RA patients starting any of the available biologic DMARDs (bDMARDs). Methods: We used the Swedish Rheumatology Register to identify patients with RA initiating TNFi, rituximab, abatacept or tocilizumab in 2010-2016 as first bDMARD (n = 9333), or after switch from TNFi as first bDMARD (n = 3941). National Swedish registers provided additional covariates and censoring events. Effectiveness was assessed 3 and 12 months after treatment start, as the proportion remaining on therapy and with EULAR Good Response, HAQ improvement >0.2, zero swollen/tender joints and CDAI remission. Adjusted differences were estimated with multivariable linear regression. Results: Patients starting non-TNFi (vs TNFi) as first bDMARD had a higher proportion remaining on drug and reaching most response outcomes as first bDMARD (1-year EULAR Good Response/HAQ improvement: TNFi 24.9/25.4%, rituximab 28.6/37.2%, abatacept 31.9/33.7%, tocilizumab 50.9/43.1%). After switch from a first TNFi, rituximab and tocilizumab, but not abatacept, were associated with significantly better response measures than TNFi (1-year EULAR Good Response/HAQ improvement: TNFi 11.6/16.1%, rituximab 24.8/33.2%, abatacept 13.1/17.5%, tocilizumab 34.1/29.4%). Differences remained significant after adjusting for potential confounders. Conclusion: Treatment outcomes among RA patients treated in Swedish clinical practice are in line with a superior effectiveness of non-TNFi bDMARDs, in particular tocilizumab and rituximab, compared with TNFi.
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Dehlin, Mats,1968Gothenburg University,Göteborgs universitet,University of Gothenburg,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine, Department of Rheumatology and Inflammation Research(Swepub:gu)xdehma
(author)
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Di Giuseppe, DanielaKarolinska Institutet,Karolinska Institute
(author)
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Feltelius, NilsSwedish medical products agency
(author)
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Turesson, CarlLund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Internal Medicine - Epidemiology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-ctn
(author)
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Askling, JohanKarolinska Institutet,Karolinska Institute
(author)
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Ernestam, S.Karolinska Institutet
(author)
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Klareskog, L.Karolinska Institutet
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Nisell, R.
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Baecklund, E.
(author)
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Kastbom, A.
(author)
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Jacobsson, L.
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Lindqvist, E.
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d'Elia, H. F.
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Rantapaa-Dahlqvist, S
(author)
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Karolinska InstitutetKarolinska Institute
(creator_code:org_t)
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ARTIS Study Group
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In:Rheumatology (United Kingdom): Oxford University Press (OUP)58:8, s. 1367-13771462-03241462-0332
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Frisell, Thomas
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Feltelius, Nils
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Turesson, Carl
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Ernestam, S.
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Klareskog, L.
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Nisell, R.
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Baecklund, E.
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Kastbom, A.
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Jacobsson, L.
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Lindqvist, E.
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d'Elia, H. F.
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