The sequence of disease-modifying anti-rheumatic drugs : pathways to and predictors of tocilizumab monotherapy
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
Arthritis research & therapy - 23(2021), 1 vom: 14. Jan., Seite 26 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Solomon, Daniel H [VerfasserIn] |
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| Links: |
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| Themen: |
Antibodies, Monoclonal, Humanized |
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| Anmerkungen: |
Date Completed 21.06.2021 Date Revised 21.06.2021 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13075-020-02408-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM320095010 |
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| 100 | 1 | |a Solomon, Daniel H |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The sequence of disease-modifying anti-rheumatic drugs |b pathways to and predictors of tocilizumab monotherapy |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a DMARDs | |
| 650 | 4 | |a Rheumatoid arthritis | |
| 650 | 4 | |a Treatment | |
| 650 | 7 | |a Antibodies, Monoclonal, Humanized |2 NLM | |
| 650 | 7 | |a Antirheumatic Agents |2 NLM | |
| 650 | 7 | |a Biological Products |2 NLM | |
| 650 | 7 | |a tocilizumab |2 NLM | |
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| 700 | 1 | |a Xu, Chang |e verfasserin |4 aut | |
| 700 | 1 | |a Collins, Jamie |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Seoyoung C |e verfasserin |4 aut | |
| 700 | 1 | |a Losina, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Yau, Vincent |e verfasserin |4 aut | |
| 700 | 1 | |a Johansson, Fredrik D |e verfasserin |4 aut | |
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