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The sequence of dis...
The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy
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- Solomon, Daniel H. (författare)
- Brigham and Women's Hospital
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- Xu, Chang (författare)
- Brigham and Women's Hospital
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- Collins, Jamie (författare)
- Brigham and Women's Hospital
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- Kim, Seoyoung C. (författare)
- Brigham and Women's Hospital
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- Losina, Elena (författare)
- Brigham and Women's Hospital
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- Yau, Vincent (författare)
- Genentech Inc.
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- Johansson, Fredrik, 1988 (författare)
- Chalmers tekniska högskola,Chalmers University of Technology
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Brigham and Women's Hospital Genentech Inc (creator_code:org_t)
- 2021-01-14
- 2021
- Engelska.
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Ingår i: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 23:1
- Relaterad länk:
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https://research.cha... (primary) (free)
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https://arthritis-re...
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https://research.cha...
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https://doi.org/10.1...
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https://research.cha...
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Abstract
Ämnesord
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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.
Ämnesord
- 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)
Nyckelord
- Rheumatoid arthritis
- Treatment
- DMARDs
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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