A systematic review of the factors associated with the initiation of biologicals in patients with rheumatological conditions

Png, Wan Yu; Kwan, Yu Heng; Lim, Ka Keat; Chew, Eng‐Hui; Lui, Nai Lee; Tan, Chuen Seng; Østbye, Truls; Thumboo, Julian; Fong, Warren

doi:10.1136/ejhpharm-2017-001431

Cited by 4 publications

(5 citation statements)

References 47 publications

(32 reference statements)

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“…There is limited and conflicting evidence regarding the impact of prescribers’ demographic characteristics and mode of practice on treatment decisions in RA [ 32 , 33 ]. Results may vary according to geographic location.…”

Section: Discussionmentioning

confidence: 99%

“…4 Standardized BW scores by a disease activity (DAS28), b presence of autoantibodies (RF/ACPA), c structural progression, d history of infection, e cardiovascular comorbidity, and f pulmonary comorbidity. ABA abatacept, ACPA anti-citrullinated protein antibodies, BWS best-worst scores, csDMARDs conventional synthetic disease-modifying anti-rheumatic drug, RF rheumatoid factor, RTX rituximab, TCZ tocilizumab, TNFI tumor necrosis inhibitors treatment decisions in RA [32,33]. Results may vary according to geographic location.…”

Section: Therapeutic Preferencesmentioning

confidence: 99%

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Elicitation of Rheumatologist Preferences for the Treatment of Patients with Rheumatoid Arthritis After the Failure of a First Conventional Synthetic Disease-Modifying Anti-Rheumatic Agent

Senbel

Durand²,

Roux³

et al. 2021

Rheumatol Ther

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Introduction: Rheumatoid arthritis (RA) clinical guidelines do not provide strong recommendations for the choice of disease-modifying anti-rheumatic drugs (DMARD) in patients with an inadequate response to methotrexate (MTX), and only limited evidence is available on factors influencing rheumatologist treatment decisions. We aimed to describe therapeutic preferences after the failure of a first-line strategy of MTX in simulated cases of patients with RA. Methods: Fictional but realistic case-vignettes (n = 64) of patients with RA and an inadequate response to MTX were developed with a combination of RA-poor prognostic factors and comorbidities. Physicians were presented with eight vignettes and chose the most and least appropriate therapeutic option from the following six options randomly proposed 3 by 3:(1) replacing MTX with another csDMARD; (2) combining MTX with one or more csDMARDs;(3) adding a bDMARD of either TNF inhibitors (TNFi), tocilizumab (TCZ), abatacept (ABA), or rituximab (RTZ). A total of 1605 complete case vignettes were produced and randomly assigned to a representative sample of French rheumatologists. For each vignette, whenever a treatment was preferred, one point was incremented for this treatment; if this treatment was the least desired, one point was removed. Preferences were elicited using a normalized best-worst score. Results: Two hundred and four French rheumatologists participated in the study with each vignette being assessed 20-28 times for a completion rate of 94%. TNFi was the firstchoice strategy (80% of vignettes), except in cases with a history of infection and pulmonary comorbidity, where ABA was the first preference (85%). TCZ came third in 83% of the cases. Other options were never preferred and repeatedly yielded negative scores. Conclusions: We observed a conservative trend with TNFi as the main therapeutic choice for patients with RA and inadequate response to MTX. Preference for bDMARD-based strategies increased with the number of RA-poor prognosis factors, whereas an increase in the number of comorbidities resulted in an increased

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Section: Discussionmentioning

confidence: 99%

Section: Therapeutic Preferencesmentioning

confidence: 99%

Elicitation of Rheumatologist Preferences for the Treatment of Patients with Rheumatoid Arthritis After the Failure of a First Conventional Synthetic Disease-Modifying Anti-Rheumatic Agent

Senbel

Durand²,

Roux³

et al. 2021

Rheumatol Ther

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“…It is therefore of interest to elucidate which features, in addition to those listed in the guidelines, may predict treatment initiation with bDMARDs or JAK inhibitors. In a systematic literature review, which included 24 relevant articles, 42 factors associated with initiation of bDMARDs were identified and divided into five clusters; patient-related, disease-related, treatment-related, healthcare staff-related and factors related to the healthcare system 5. However, the review did not include any meta-analysis of the relative importance of these different factors 5.…”

Section: Introductionmentioning

confidence: 99%

“…In a systematic literature review, which included 24 relevant articles, 42 factors associated with initiation of bDMARDs were identified and divided into five clusters; patient-related, disease-related, treatment-related, healthcare staff-related and factors related to the healthcare system. 5 However, the review did not include any meta-analysis of the relative importance of these different factors. 5 Furthermore, such features may change over time or vary by ethnic populations and the availability of bDMARDs/tsDMARDs.…”

Section: Introductionmentioning

confidence: 99%

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Predictors at diagnosis for start of biologic disease-modifying antirheumatic drugs in patients with early rheumatoid arthritis: a cohort study

Hameed,

Exarchou,

Eberhard

et al. 2024

BMJ Open

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ObjectivesTo investigate the relation between patient characteristics at rheumatoid arthritis (RA) diagnosis and subsequent initiation of treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs).DesignA retrospective cohort study.Setting and participantsConsecutive patients (N=330) with early RA (symptom duration <12 months) diagnosed at Skåne University Hospital, Malmö/Lund, Sweden, from 2012 to 2016, were included. Data on demographics, education, comorbidities and treatment were obtained from national registers.OutcomeThe relation between patient characteristics at diagnosis and time to first bDMARD/tsDMARD initiation was analysed using Cox regression models. As a secondary outcome, the relation between characteristics at diagnosis and b/tsDMARD initiation within 3 years was analysed using logistic regression.ResultsA total of 330 patients (mean age 59.2 years; SD 16.4) were included. During follow-up, 41% received a bDMARD (never preceded by a tsDMARD). Higher age at diagnosis was associated with a lower probability of starting bDMARD treatment (multivariable-adjusted HR 0.66 per SD; 95% CI 0.56 to 0.78). Anticitrullinated protein antibody (ACPA) positivity and higher tender joint count at diagnosis were also associated with subsequent bDMARD treatment initiation in multivariable analysis. A higher level of formal education and absence of comorbidities predicted start of a bDMARD in crude, but not in age-adjusted, analyses.ConclusionsOlder patients with RA were less likely to start bDMARDs, whereas ACPA-positive patients, and those with extensive joint involvement at diagnosis, were more likely to receive early bDMARD treatment. The impact of age on the subsequent start of bDMARD therapy was not explained by level of education or comorbidities, suggesting that other aspects of age influence treatment decisions in early RA.

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Biologic Initiation Rate in Systemic-Naïve Psoriatic Arthritis Patients Starting Treatment with Apremilast vs Methotrexate: 1-Year Retrospective Analysis of a US Claims Database

Husni¹,

Chang²,

Broder³

et al. 2022

OARRR

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Purpose To compare the rate of biologic initiation after commencing treatment with apremilast (APR) vs methotrexate (MTX), in systemic-naïve patients with psoriatic arthritis (PsA). Patients and Methods Systemic-naïve patients with PsA who started treatment with either APR or MTX between 01/01/2015 and 12/31/2018 were analyzed using claims data from the IBM ® MarketScan ® Commercial and Medicare Supplemental databases (2014–2019). PsA patients were identified via diagnosis codes; the first prescription date for APR or MTX was the index date. Patient demographics, clinical characteristics, healthcare utilization during the year pre-index (baseline) and the year post-index (follow-up), and median time to biologic initiation were reported descriptively. The rates and risk of biologic initiation during follow-up were compared between APR and MTX users by logistic and Cox regressions, respectively. Models were adjusted for demographics, clinical and utilization measures during the baseline period. Results A total of 2116 patients with PsA newly treated with APR (n = 534) or MTX (n = 1582) were identified. Mean age was similar (50.5 vs 50.4; P = 0.938), and proportion of females was higher for APR vs MTX users (59.4% vs 54.0%; P = 0.031). Mean time to biologic initiation among patients who initiated during follow-up was 194.1 vs 138.7 days between APR vs MTX users ( P < 0.001). After adjusting for confounders, the likelihood of biologic initiation was 58% lower (OR, 0.42 [95% CI, 0.32–0.54]; P < 0.001) with APR, with a significantly lower predicted rate of biologic initiation among APR users when compared to MTX users during follow-up (20.0% [95% CI, 16.6–23.9%] vs 37.5% [95% CI, 35.0–40.1%]). Additionally, APR users had a lower risk of biologic initiation than MTX users (HR, 0.46 [95% CI, 0.37–0.57]; P < 0.001) during the 1-year follow-up. Conclusion Systemic-naïve patients with PsA have a lower rate of, and longer time to, biologic initiation over one-year following APR initiation, compared to those initiating MTX.

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A systematic review of the factors associated with the initiation of biologicals in patients with rheumatological conditions

Cited by 4 publications

References 47 publications

Elicitation of Rheumatologist Preferences for the Treatment of Patients with Rheumatoid Arthritis After the Failure of a First Conventional Synthetic Disease-Modifying Anti-Rheumatic Agent

Elicitation of Rheumatologist Preferences for the Treatment of Patients with Rheumatoid Arthritis After the Failure of a First Conventional Synthetic Disease-Modifying Anti-Rheumatic Agent

Predictors at diagnosis for start of biologic disease-modifying antirheumatic drugs in patients with early rheumatoid arthritis: a cohort study

Biologic Initiation Rate in Systemic-Naïve Psoriatic Arthritis Patients Starting Treatment with Apremilast vs Methotrexate: 1-Year Retrospective Analysis of a US Claims Database

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