在炎症性关节炎患者中确定第一线皮下TNF抑制剂持久性的预测因素:根据指示进行决策树分析
Johan Dalén1, Axel Svedbom1, Emma Hernlund1
1ICON Plc, Stockholm, Sweden.
Advances in therapy
|August 20, 2023
概括
这项研究发现,性别和特定的治疗方法影响皮下瘤缩因子抑制剂 (SC-TNFi) 在炎症性关节炎 (IA) 中的持续性. 识别这些因素可以改善治疗策略和患者的治疗结果.
科学领域:
- 类风湿病学 类风湿病学
- 药物经济学 药物经济学
- 生物统计学 生物统计学
背景情况:
- 在炎症性关节炎 (IA) 中,治疗的持续性对疗效,安全和患者满意度至关重要,这会影响医疗保健成本.
- 确定影响持续性的因素对于优化治疗策略和减少经济负担至关重要.
- 传统的回归分析存在局限性;统计学习为了解治疗持续性提供了新的方法.
研究的目的:
- 在IA中确定具有明显持续性皮下瘤亡因子抑制剂 (SC-TNFi) 治疗的患者组.
- 利用全国范围的瑞典行政数据和递归分区进行增强分析.
- 在不同IA诊断中发现与SC-TNFi治疗持久性相关的因素.
主要方法:
- 利用了2010-2017年期间开始SC-TNFi的成年,生物素朴的IA患者的瑞典全国性行政登记数据.
- 定义的IA为类风湿性关节炎 (RA),结性脊柱炎/未指定的脊柱炎 (AS/uSpA) 或牛皮性关节炎 (PsA).
- 在条件推理框架中使用递归分区来识别基于SC-TNFi持久性和特征的患者群.
主要成果:
- 包括13,913名患者:50%的RA,27%的AS/uSpA,23%的PSA.
- 递归分区将性别和治疗确定为SC-TNFi在PsA和AS/uSpA中的持久性关键因素.
- 最低的持久性为9.5-11.3个月;最高的持久性因指示而有显著差异 (18.4-48.9个月).
结论:
- 女性性别与在PsA和AS/uSpA中较低的SC-TNFi持久性有关.
- 男性性别和golimumab与在PsA和AS/uSpA中较高的SC-TNFi持久性有关.
- 导致RA持续的因素不太明确,但可能涉及疾病活动和传统的DMARD使用.
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