Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis
Aims: To determine real-life biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.Metho...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-09-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.708168/full |
| _version_ | 1819137499313733632 |
|---|---|
| author | Vandana Bhushan Vandana Bhushan Susan Lester Susan Lester Liz Briggs Raif Hijjawi E. Michael Shanahan E. Michael Shanahan Eliza Pontifex Eliza Pontifex Jem Ninan Catherine Hill Catherine Hill Fin Cai Fin Cai Jennifer Walker Jennifer Walker Fiona Goldblatt Fiona Goldblatt Mihir D. Wechalekar Mihir D. Wechalekar |
| author_facet | Vandana Bhushan Vandana Bhushan Susan Lester Susan Lester Liz Briggs Raif Hijjawi E. Michael Shanahan E. Michael Shanahan Eliza Pontifex Eliza Pontifex Jem Ninan Catherine Hill Catherine Hill Fin Cai Fin Cai Jennifer Walker Jennifer Walker Fiona Goldblatt Fiona Goldblatt Mihir D. Wechalekar Mihir D. Wechalekar |
| author_sort | Vandana Bhushan |
| collection | DOAJ |
| description | Aims: To determine real-life biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.Methods: Time-to-event analysis for mean treatment duration (estimated as the Restricted Mean Survival Time), b/tsDMARD failure, and b/tsDMARDs switching was performed for 230 patients (n = 147 RA, 46 PsA, 37 AS) who commenced their first b/tsDMARD between 2008 and 2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of b/tsDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. Treatment retention data was compared to a historical analysis (2002–2008).Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third b/tsDMARDs across all patients (p = 0.46). When compared to RA patients, the risk of b/tsDMARD failure was halved in PsA patients [Hazard Ratio (HR) = 0.50], but no different in AS patients (HR = 1.0). The respective restricted mean (95%CI) treatment durations, estimated at 5 years of follow-up, were 3.1 (2.9, 3.4), 4.1 (3.7, 4.6), and 3.3 (2.8, 3.9) years, for RA, PsA, and AS, respectively. Age, gender, disease duration, smoking status and the use of concomitant csDMARDS were not associated with the risk of bDMARD failure. The most common reasons for switching in the first and subsequent years were secondary (n = 62) and primary (n = 35) failure. Comparison with historical data indicated no substantive differences in switching of the first biologic for RA and PsA.Conclusion: Similar retention rates of the second and third compared to the first b/tsDMARD in RA, PsA, and AS support a strategy of differential b/tsDMARDs use informed by patient presentation. Despite greater availability of b/tsDMARDs with differing mechanisms of action, retention rates of the first b/tsDMARD remain similar to previous years. |
| first_indexed | 2024-12-22T10:51:51Z |
| format | Article |
| id | doaj.art-1e12a83da0a14ff0aaa971a0138dfa1f |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-22T10:51:51Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-1e12a83da0a14ff0aaa971a0138dfa1f2022-12-21T18:28:44ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-09-01810.3389/fmed.2021.708168708168Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing SpondylitisVandana Bhushan0Vandana Bhushan1Susan Lester2Susan Lester3Liz Briggs4Raif Hijjawi5E. Michael Shanahan6E. Michael Shanahan7Eliza Pontifex8Eliza Pontifex9Jem Ninan10Catherine Hill11Catherine Hill12Fin Cai13Fin Cai14Jennifer Walker15Jennifer Walker16Fiona Goldblatt17Fiona Goldblatt18Mihir D. Wechalekar19Mihir D. Wechalekar20Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaDivision of Medicine, Flinders Medical Centre, Adelaide, SA, AustraliaRheumatology Unit, Queen Elizabeth Hospital, Adelaide, SA, AustraliaDiscipline of Medicine, The University of Adelaide, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaDivision of Medicine, Flinders Medical Centre, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaRheumatology Unit, Queen Elizabeth Hospital, Adelaide, SA, AustraliaRheumatology Unit, Queen Elizabeth Hospital, Adelaide, SA, AustraliaDiscipline of Medicine, The University of Adelaide, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaRheumatology Unit, Flinders Medical Centre, Adelaide, SA, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA, AustraliaAims: To determine real-life biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.Methods: Time-to-event analysis for mean treatment duration (estimated as the Restricted Mean Survival Time), b/tsDMARD failure, and b/tsDMARDs switching was performed for 230 patients (n = 147 RA, 46 PsA, 37 AS) who commenced their first b/tsDMARD between 2008 and 2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of b/tsDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. Treatment retention data was compared to a historical analysis (2002–2008).Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third b/tsDMARDs across all patients (p = 0.46). When compared to RA patients, the risk of b/tsDMARD failure was halved in PsA patients [Hazard Ratio (HR) = 0.50], but no different in AS patients (HR = 1.0). The respective restricted mean (95%CI) treatment durations, estimated at 5 years of follow-up, were 3.1 (2.9, 3.4), 4.1 (3.7, 4.6), and 3.3 (2.8, 3.9) years, for RA, PsA, and AS, respectively. Age, gender, disease duration, smoking status and the use of concomitant csDMARDS were not associated with the risk of bDMARD failure. The most common reasons for switching in the first and subsequent years were secondary (n = 62) and primary (n = 35) failure. Comparison with historical data indicated no substantive differences in switching of the first biologic for RA and PsA.Conclusion: Similar retention rates of the second and third compared to the first b/tsDMARD in RA, PsA, and AS support a strategy of differential b/tsDMARDs use informed by patient presentation. Despite greater availability of b/tsDMARDs with differing mechanisms of action, retention rates of the first b/tsDMARD remain similar to previous years.https://www.frontiersin.org/articles/10.3389/fmed.2021.708168/fullbiologic DMARDsretentionswitchingrheumatoid arthritispsoriatic arthritisankylosing spondylitis |
| spellingShingle | Vandana Bhushan Vandana Bhushan Susan Lester Susan Lester Liz Briggs Raif Hijjawi E. Michael Shanahan E. Michael Shanahan Eliza Pontifex Eliza Pontifex Jem Ninan Catherine Hill Catherine Hill Fin Cai Fin Cai Jennifer Walker Jennifer Walker Fiona Goldblatt Fiona Goldblatt Mihir D. Wechalekar Mihir D. Wechalekar Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis Frontiers in Medicine biologic DMARDs retention switching rheumatoid arthritis psoriatic arthritis ankylosing spondylitis |
| title | Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis |
| title_full | Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis |
| title_fullStr | Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis |
| title_full_unstemmed | Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis |
| title_short | Real-Life Retention Rates and Reasons for Switching of Biological DMARDs in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis |
| title_sort | real life retention rates and reasons for switching of biological dmards in rheumatoid arthritis psoriatic arthritis and ankylosing spondylitis |
| topic | biologic DMARDs retention switching rheumatoid arthritis psoriatic arthritis ankylosing spondylitis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.708168/full |
| work_keys_str_mv | AT vandanabhushan realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT vandanabhushan realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT susanlester realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT susanlester realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT lizbriggs realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT raifhijjawi realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT emichaelshanahan realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT emichaelshanahan realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT elizapontifex realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT elizapontifex realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT jemninan realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT catherinehill realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT catherinehill realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT fincai realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT fincai realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT jenniferwalker realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT jenniferwalker realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT fionagoldblatt realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT fionagoldblatt realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT mihirdwechalekar realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis AT mihirdwechalekar realliferetentionratesandreasonsforswitchingofbiologicaldmardsinrheumatoidarthritispsoriaticarthritisandankylosingspondylitis |