Adherence to biologic disease-modifying antirheumatic drugs in adult patients with rheumatic diseases

ObjectivesTo describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.MethodsAn observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.ResultsThe study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.ConclusionOur results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

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Clinical course and outcome of COVID-19 in patients with rheumatic diseases: are all biological disease-modifying antirheumatic drugs alike? Response to: ‘Increased risk for severe COVID-19 in patients with inflammatory rheumatic diseases treated with rituximab’ by Schulze-Koops et al

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-218148 ◽

2020 ◽

pp. annrheumdis-2020-218148

Author(s):

Sara Monti ◽

Carlomaurizio Montecucco

Keyword(s):

Rheumatic Diseases ◽

Clinical Course ◽

Inflammatory Rheumatic Diseases ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Increased Risk ◽

Disease Modifying

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Efficacy of roxithromycin in adult patients with rheumatoid arthritis who had not received disease-modifying antirheumatic drugs: A 3-month, randomized, double-blind, placebo-controlled trial

Clinical Therapeutics ◽

10.1016/j.clinthera.2009.08.014 ◽

2009 ◽

Vol 31 (8) ◽

pp. 1754-1764 ◽

Cited By ~ 20

Author(s):

Mesut Ogrendik

Keyword(s):

Rheumatoid Arthritis ◽

Controlled Trial ◽

Adult Patients ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Double Blind ◽

Double Blind Placebo ◽

Disease Modifying

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Biologic Disease-modifying Antirheumatic Drug (bDMARD)-induced Neutropenia: A Registry from a Retrospective Cohort of Patients with Rheumatic Diseases Treated with 3 Classes of Intravenous bDMARD

The Journal of Rheumatology ◽

10.3899/jrheum.150457 ◽

2017 ◽

Vol 44 (6) ◽

pp. 844-849 ◽

Cited By ~ 8

Author(s):

Francisco Espinoza ◽

Pierre Le Blay ◽

Bernard Combe

Keyword(s):

Rheumatic Diseases ◽

Retrospective Cohort ◽

Concomitant Treatment ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Drug Survival ◽

History Of ◽

Severe Infections ◽

Risks Factors ◽

Disease Modifying

Objective.To examine the rate, risks factors, and consequences of neutropenia induced by intravenous (IV) biologic disease-modifying antirheumatic drugs (bDMARD).Methods.We conducted a retrospective cohort study in 499 patients with rheumatic diseases treated by IV abatacept (ABA), infliximab (IFX), or tocilizumab (TCZ).Results.Rheumatoid arthritis (RA) was the most frequent diagnosis (72%). Fifty-two patients (10.4%) experienced at least 1 episode of neutropenia. No episodes of grade 4 neutropenia were documented. TCZ was more frequently related to neutropenia than ABA or IFX (18.6% vs 3.8% and 2.8%, respectively, p < 0.001). The following factors were identified as predictors of experiencing neutropenia with IV bDMARD: history of neutropenia with methotrexate (MTX; synthetic DMARD; OR 1.56, 95% CI 1.17–7.14), concomitant treatment by MTX (OR 1.21, 95% CI 1.01–2.64), and TCZ treatment (OR 2.72, 95% CI 1.53–9.05). Patients experiencing a TCZ-induced neutropenia did not show a higher risk of severe infections; however, this group had a shorter drug survival (9 mos vs 20 mos, p < 0.02) compared with TCZ patients without neutropenia.Conclusion.Among 3 different classes of IV bDMARD, TCZ is associated with the higher risk of neutropenia. No increased frequency of infection episodes was documented in this group.

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UTILIZATION PATTERNS OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS) IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES

FARMACIA ◽

10.31925/farmacia.2019.1.25 ◽

2019 ◽

Vol 67 (1) ◽

pp. 184-192

Author(s):

LAURA-ALEXANDRA ANGHEL

Keyword(s):

Rheumatic Diseases ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Autoimmune Rheumatic Diseases ◽

Utilization Patterns ◽

Disease Modifying

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Comparative effectiveness of first-line biological monotherapy use in rheumatoid arthritis: a retrospective analysis of the RECord-linkage On Rheumatic Diseases study on health care administrative databases

BMJ Open ◽

10.1136/bmjopen-2017-021447 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021447 ◽

Cited By ~ 8

Author(s):

Ettore Silvagni ◽

Alessandra Bortoluzzi ◽

Greta Carrara ◽

Anna Zanetti ◽

Marcello Govoni ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Rheumatic Diseases ◽

Record Linkage ◽

Disease Duration ◽

Retention Rate ◽

First Line ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Risk Of Failure ◽

Disease Modifying

ObjectiveThese analyses aim to comparatively evaluate the persistence on treatment of different biological disease-modifying antirheumatic drugs (bDMARDs) when administered in monotherapy compared with combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in rheumatoid arthritis (RA) patients receiving first-line biologics.DesignThis is a retrospective observational study on Administrative Healthcare Databases.MethodsData were extracted from healthcare databases of the Lombardy Region, Italy (2004–2013), as a part of the RECord-linkage On Rheumatic Diseases study, on behalf of the Italian Society for Rheumatology. Analyses included patients with RA starting first-line approved course of bDMARDs and evaluated drug survival by using Cox proportional hazard models. Results are presented as HRs and 95% CI, crude and adjusted for prespecified confounders (age, sex, disease duration, Charlson Comorbidity Index (CCI), previous infections, use of concomitant glucocorticoids or non-steroidal anti-inflammatory drugs (NSAIDs)).Results4478 patients with RA were included (17.84% monotherapy). Etanercept, adalimumab and infliximab were the most prescribed first-line biologics. bDMARD monotherapy was associated with longer disease duration, higher CCI, lower glucocorticoids and NSAIDs use. Compared with monotherapy, combination associated with a lower risk of failure (adjusted HR 0.79, 95% CI 0.72 to 0.88). Among monotherapies, considering etanercept as reference, adalimumab (1.28, 95% CI 1.03 to 1.59) and infliximab (2.41, 95% CI 1.85 to 3.15) had higher risk of failure. Concomitant methotrexate (0.78, 95% CI 0.70 to 0.87), leflunomide (0.80, 95% CI 0.65 to 0.98) or csDMARD combinations (0.77, 95% CI 0.68 to 0.87) reduced the risk of bDMARD withdrawal.ConclusionAdalimumab and infliximab monotherapies show lower retention rate compared with etanercept. The relatively small number of therapeutic courses different from tumour necrosis factor (TNF) inhibitors makes more difficult to achieve conclusive results with other biologics. Concomitant methotrexate, leflunomide and csDMARDs combination associate with longer survival on bDMARD. Our data confirm the effectiveness of the current practices in the choice of etanercept as first-line anti-TNF monotherapy and strengthen the currently recommended use of bDMARDs in combination with csDMARDs.

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