Abstract

Objectives

Long-term real-world management of inflammatory rheumatic diseases remains unclear, especially with the advent of new treatment options. This study characterizes the number of advanced treatments used by patients with selected rheumatic diseases (rheumatoid arthritis [RA], psoriatic arthritis [PsA], ankylosing spondylitis, juvenile idiopathic arthritis) and provides a contemporary portrait of treatment patterns and therapeutic sequencing among patients with RA and PsA.

Method

Patients were selected from a large US claims database and classified into disease subsamples based on the latest rheumatic diagnosis recorded before/on the day of initiation of the first advanced treatment (index date). The total number of advanced treatments was assessed within the first 5 years following the index date. Treatment patterns and therapeutic sequencing were assessed over the first 2 years.

Results

Approximately 20% of patients received ≥2 distinct advanced treatments during the first year following index date – the proportion increased to almost 50% among patients with 5 years of observation. Most patients (RA: 76.8%; PsA: 88.7%) initiated a tumor necrosis factor as the first advanced treatment. Over the first 2 years after the index date, 1/3 of RA and PsA patients switched to another advanced treatment. More than 50% initiated a second treatment with the same mechanism of action (MOA). A small proportion of patients received a biosimilar.

Conclusion

Despite advent of treatments with different MOA, cycling between treatments with the same MOA was common. Further studies with longer data follow-up would be needed to assess the impact of higher adoption of biosimilars on treatment patterns/sequencing.

中文翻译：

---

风湿病患者的治疗模式和顺序：回顾性索赔数据分析

摘要

目标

炎症性风湿病的长期现实世界管理仍不清楚，尤其是随着新治疗方案的出现。本研究描述了某些风湿性疾病（类风湿性关节炎 [RA]、银屑病关节炎 [PsA]、强直性脊柱炎、幼年特发性关节炎）患者使用的高级治疗的数量，并提供了 RA 患者治疗模式和治疗顺序的当代画像和PSA。

方法

从大型美国索赔数据库中选择患者，并根据在第一次高级治疗开始之前/当天（索引日期）记录的最新风湿病诊断将其分类为疾病子样本。在索引日期后的前 5 年内评估了先进治疗的总数。治疗模式和治疗顺序在前 2 年进行了评估。

结果

大约 20% 的患者在索引日期后的第一年内接受了 ≥2 种不同的高级治疗——在观察 5 年的患者中，这一比例增加到近 50%。大多数患者（RA：76.8%；PsA：88.7%）开始使用肿瘤坏死因子作为第一个高级治疗。在索引日期后的前 2 年内，1/3 的 RA 和 PsA 患者转而接受另一种高级治疗。超过 50% 的患者使用相同的作用机制 (MOA) 进行了第二次治疗。一小部分患者接受了生物仿制药。

结论

尽管出现了具有不同 MOA 的治疗方法，但在具有相同 MOA 的治疗之间循环是很常见的。需要进行更长时间的数据跟踪研究，以评估更多地采用生物仿制药对治疗模式/测序的影响。