对瘤亡因子抑制剂在类风湿性关节炎中的最佳粘附值的估计
Jennifer Toth Harris1, Yi Yang2, John P Bentley2
1Verana Health, 360 3rd St, San Francisco, CA, 94107, USA. tothjm1@gmail.com.
Clinical rheumatology
|June 9, 2024
概括
在类风湿性关节炎 (RA) 患者中,瘤亡因子 (TNF) 抑制剂的最佳坚持值约为60%,低于传统的80%. 更高的坚持减少了使用葡萄糖皮质激素和住院的风险,但可能会增加急诊室的访问.
科学领域:
- 类风湿病学 类风湿病学
- 药物经济学 药物经济学
- 健康 结果 研究 研究 结果
背景情况:
- 药物的坚持值,包括瘤亡因子 (TNF) 抑制剂,可以根据特定的药物和疾病状况而有所不同.
- 确定保险日的最佳比例 (PDC) 对于管理类风湿性关节炎 (RA) 治疗的有效性和安全性至关重要.
研究的目的:
- 在被诊断为RA的患者中确定TNF抑制剂的最佳PDC值.
- 分析PDC与RA患者的关键临床结果之间的关联,这些患者开始使用TNF抑制剂.
主要方法:
- 利用了2012-2018年RA患者开始使用TNF抑制剂的Medicare服务费索赔数据.
- 计算了90天间的时间变化的PDC,并评估了包括葡萄糖皮质类药物使用,住院治疗,急诊和严重感染在内的结果.
- 使用考克斯回归和动态ROC曲线与Youden的J指数来确定365天的最佳PDC值.
主要成果:
- 在1190名RA患者中,75%的人至少经历了一次不良结果.
- 10%的PDC增加与复合结局 (HR 0.98),口服葡萄糖皮质体使用 (HR 0.93) 和住院 (HR 0.96) 的风险降低相关.
- 综合结果的最佳PDC值为0.64,口服葡萄糖皮质激素使用为0.59,住院治疗为0.56.
结论:
- 在RA患者中,TNF抑制剂的最佳PDC约为60%,这表明坚持基准比传统的80%低.
- 增加对TNF抑制剂的坚持与特定不良事件的风险降低有关,尽管急诊室访问显示略有增加.
- 随时变化的90天PDC的平均值从第1天的92%下降到第365天的62%随访.
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