The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy

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Solomon, Daniel H.Brigham and Women's Hospital (author)

The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy

Article/chapterEnglish2021

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2021-01-14
Springer Science and Business Media LLC,2021
electronicrdacarrier

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LIBRIS-ID:oai:research.chalmers.se:87ed6e01-de63-490e-8591-8d7b9cf5c28e
https://research.chalmers.se/publication/522176URI
https://doi.org/10.1186/s13075-020-02408-4DOI
https://research.chalmers.se/publication/522283URI

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Language:English
Summary in:English

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SwePubSwePub

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Subject category:art swepub-publicationtype
Subject category:ref swepub-contenttype

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Background: There are numerous non-biologic and biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods: We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every 6 months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use. Results: 7300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. Eighty-two percent of TCZm use began within 3 years of starting any bDMARD. Ninety-three percent of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with the use of TCZm included prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor. Conclusions: Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Medicinska och farmaceutiska grundvetenskaper Farmaceutiska vetenskaper hsv//swe
MEDICAL AND HEALTH SCIENCES Basic Medicine Pharmaceutical Sciences hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Medicinska och farmaceutiska grundvetenskaper Immunologi inom det medicinska området hsv//swe
MEDICAL AND HEALTH SCIENCES Basic Medicine Immunology in the medical area hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Reumatologi och inflammation hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Rheumatology and Autoimmunity hsv//eng
Rheumatoid arthritis
Treatment
DMARDs

Added entries (persons, corporate bodies, meetings, titles ...)

Xu, ChangBrigham and Women's Hospital (author)
Collins, JamieBrigham and Women's Hospital (author)
Kim, Seoyoung C.Brigham and Women's Hospital (author)
Losina, ElenaBrigham and Women's Hospital (author)
Yau, VincentGenentech Inc. (author)
Johansson, Fredrik,1988Chalmers tekniska högskola,Chalmers University of Technology(Swepub:cth)frejohk (author)
Brigham and Women's HospitalGenentech Inc. (creator_code:org_t)

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In:Arthritis Research and Therapy: Springer Science and Business Media LLC23:11478-63621478-6354

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