The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy
| العنوان: | The sequence of disease-modifying anti-rheumatic drugs: pathways to and predictors of tocilizumab monotherapy |
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| المؤلفون: | Solomon, Daniel H., Xu, Chang, Collins, Jamie, Kim, Seoyoung C., Losina, Elena, Yau, Vincent, Johansson, Fredrik, 1988 |
| المصدر: | Arthritis Research and Therapy. 23(1) |
| مصطلحات موضوعية: | Rheumatoid arthritis, Treatment, DMARDs |
| الوصف: | Background: There are numerous non-biologic and biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods: We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every 6 months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use. Results: 7300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. Eighty-two percent of TCZm use began within 3 years of starting any bDMARD. Ninety-three percent of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with the use of TCZm included prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor. Conclusions: Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data. |
| وصف الملف: | electronic |
| الوصول الحر: | https://research.chalmers.se/publication/522176Test https://research.chalmers.se/publication/522283Test https://research.chalmers.se/publication/522283/file/522283_Fulltext.pdfTest |
| قاعدة البيانات: | SwePub |
| تدمد: | 14786362 14786354 |
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| DOI: | 10.1186/s13075-020-02408-4 |