Use of a disease risk score to compare serious infections associated with anti–tumor necrosis factor therapy among high‐ versus lower‐risk rheumatoid arthritis patients

Abstract

Background The metrics used to assess quality of care and pay for performance are increasingly important. Medicare established the Physician Quality Reporting System (PQRS) that allowed physicians to report performance measures for many conditions including osteoporosis and rheumatoid arthritis (RA). We described the frequency and nature of physician-reported reasons why recommended care for individual osteoporosis and RA patients was not provided. Methods Using national data on Medicare fee-for-service beneficiaries (2007-2009), we identified healthcare providers reporting on quality of care for any of 3 osteoporosis or 3 RA measures. PQRS reason codes allowed physicians to submit explanations why recommended care was not given. Results In 2009, 1775 physicians reported on >= 1 osteoporosis PQRS measure, and 630 physicians reported on >= 1 RA measure. For patients for whom their physician reported via PQRS on lifetime DXA screening since age 60, 76% of older women had received such screening. Among patients with physician-diagnosed osteoporosis reported via PQRS, 82% received prescription osteoporosis medication in the preceding year. For RA medication use reported via PQRS, 89% of patients received a DMARD or a biologic. For the remaining 11-24% of osteoporosis and RA patients, their physicians reported medical, patient, system, or other reasons why care was considered but not provided. Conclusions A substantial fraction of Medicare enrollees who did not receive recommended osteoporosis or RA care had physician-documented reasons for why care was not provided. For Medicare and other health plans that implement penalties for apparent nonperformance (or delivery of suboptimal care), it will be important for allow physicians to provide reasons that care was considered medically inappropriate, refused, or otherwise not feasible.

Efficacy and Safety of Rituximab in Elderly Patients With Rheumatoid Arthritis Enrolled in a French Society of Rheumatology Registry

“…No increased risk of infection with age was reported for the first time by Schneeweiss et al in a population of 15,597 patients age Ͼ75 years initiating anti-TNF therapy, and has also not been seen in the Swiss and Dutch anti-TNF registries (20 -22). A recent study by Curtis et al showed that the rate of serious infections for anti-TNF agents was incrementally increased by a fixed absolute difference irrespective of age, comorbidities, and other factors that contribute to infections (23). No data concerning the risk of infection in elderly patients treated with abatacept are available.…”

“…age, and respiratory infections were most common ( 23.6% (25 of 106) of the 65-74 years group, and 13.1% (6 of 46) of the Ͻ75 years age group were EULAR good responders. At this same time point, a EULAR moderate response was achieved in 48.6%, 37.2%, 44.3%, and 56.5%, respectively.…”

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

“…[10][11][12][13][14][15][16] Among patients with autoimmune inflammatory conditions such as psoriasis, the incidence of serious infectious events (SIEs) is increased among those using antipsoriatic treatments. [17][18][19][20] Some studies suggest lower rates among patients < 65 years old compared with patients aged 65 and older. [17][18][19][20] However, when considering specific tumour necrosis factor (TNF)-a-antagonist therapy, one study found patients ≤ 65 have nearly a 3-fold greater rate of SIEs among patients exposed to infliximab, as compared with etanercept or adalimumab-exposed patients.…”

“…[17][18][19][20] Some studies suggest lower rates among patients < 65 years old compared with patients aged 65 and older. [17][18][19][20] However, when considering specific tumour necrosis factor (TNF)-a-antagonist therapy, one study found patients ≤ 65 have nearly a 3-fold greater rate of SIEs among patients exposed to infliximab, as compared with etanercept or adalimumab-exposed patients. 17 In a review of the studies that evaluated the effect of TNF-a-antagonist therapy on infection risk, 20 these discrepancies in risk were attributed to differences in study design, comparator groups and analytical methods (e.g.…”

Overview of biologic treatments in the elderly

“…Non-pharmacological risk factors for infection in elderly RA patients include high comorbidity, elevated markers of disease severity and history of previous infection [31]. Like the csDMARDs, TNF antagonists are associated with a moderately increased absolute risk of serious infection, with no difference between age categories [32][33][34]. There are few studies involving head-to-head comparisons.…”