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Persistence and costs with subcutaneous TNF-alpha inhibitors in immune-mediated rheumatic disease stratified by treatment line

机译：皮下注射TNF-α抑制剂在免疫介导的风湿性疾病中的持久性和成本

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Objectives: The objectives of this study were to 1) describe and compare treatment persistence with first- and second-line subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) (collectively immune-mediated rheumatic disease) in Sweden and 2) estimate and contrast health care costs in the two groups. Methods: Patients who initiated their first or second SC-TNFi between May 6 2010 and December 12 2012 were identified from the Prescribed Drug Register. Persistence was estimated using survival analysis. Costs comprised specialized outpatient care, inpatient care, and medication. The persistence analysis was stratified by immune-mediated rheumatic disease diagnosis. Results: A total of 4,903 patients treated with their first and 845 patients treated with their second SC-TNFi were identified. Baseline characteristics differed between the two groups. Therefore, propensity score matching analysis was implemented. Second-line patients were matched to first-line patients, and four cohort pairs (AS, PsA, RA, and all diagnoses combined) were generated. Patients treated with their first SC-TNFi had statistically significant higher persistence than patients treated with their second SC-TNFi in PsA ( P =0.036), RA ( P =0.048), and all diagnoses combined ( P <0.001) but not in AS ( P =0.741). Patients who were treated with their second SC-TNFi incurred higher costs than patients treated with their first SC-TNFi. Conclusion: Overall, persistence to the first SC-TNFi was higher than persistence to the second SC-TNFi. Furthermore, the second SC-TNFi was associated with higher costs than the first SC-TNFi. Therefore, prescribing the SC-TNFi with the best long-term persistence first may be beneficial.
机译：目的：本研究的目的是：1）描述和比较强直性脊柱炎（AS），银屑病关节炎（PsA），一线和二线皮下肿瘤坏死因子-α抑制剂（SC-TNFis）的治疗持久性，或瑞典的类风湿关节炎（RA）（集体免疫介导的风湿性疾病）和2）估算并对比了两组的医疗保健费用。方法：从处方药登记簿中识别出在2010年5月6日至2012年12月12日之间开始其第一个或第二个SC-TNFi的患者。使用生存分析评估持久性。费用包括专门的门诊护理，住院护理和药物治疗。持续性分析通过免疫介导的风湿性疾病诊断进行分层。结果：总共鉴定了4,903例接受第一次SC-TNFi治疗的患者和845例接受了第二次SC-TNFi治疗的患者。两组之间的基线特征不同。因此，实施了倾向得分匹配分析。二线患者与一线患者匹配，并产生了四对队列（AS，PsA，RA和所有诊断合并）。在PSs（P = 0.036），RA（P = 0.048）和所有合并诊断中（P <0.001）但在AS中未进行首次SC-TNFi治疗的患者的持久性在统计学上要比第二次SC-TNFi治疗的患者更高。 （P = 0.741）。用第二种SC-TNFi治疗的患者比用第一种SC-TNFi治疗的患者产生更高的费用。结论：总体而言，对第一个SC-TNFi的持久性高于对第二个SC-TNFi的持久性。此外，与第一SC-TNFi相比，第二SC-TNFi具有更高的成本。因此，首先以最佳长期持久性开出SC-TNFi可能是有益的。

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