SAT0720-HPR Longitudinal analysis of response, costs and resource use of patients with rheumatoid arthritis initiating biologic disease-modifying antirheumatic drugs (BDMARDS) in taiwan using the national health insurance research database

Background:Rheumatoid arthritis (RA) patients treated with advanced therapy (biologic disease-modifying antirheumatic drugs and targeted synthetic disease-modifying antirheumatic drugs) may be considered dose tapering after reaching treatment goal.1In EULAR 2016 recommendations, dose reduction can be considered if patients reach sustained remission.2A dose tapering policy of advanced therapy was introduced in the treatment guideline of RA since 2014 under the National Health Insurance (NHI) in Taiwan. The new reimbursement policy requests the dosage to be tapered in patients who received advanced therapy for 2 years and reached low disease activity defined by DAS28 (ESR).Objectives:This retrospective study aims to investigate the impact of dose tapering policy on prescription pattern of advanced therapy for RA patients in Taiwan.Methods:This study was an observational retrospective analysis on the population-based National Health Insurance Research Database (NHIRD) in Taiwan. Patients with RA aged ≥18, initiated an index advanced therapy - abatacept, adalimumab, etanercept, golimumab, tocilizumab, or tofacitinib, during 2011-2017 were included (Figure 1). Patients were followed-up until the index advanced therapy was switched/discontinued or the end of data, whichever came first. The 4-week moving average of proportion of days covered (PDC) of the index therapy within each 12-week period were assessed. The outcome variable was whether dose tapering occurred which was defined as PDC being less than 0.5. The odds ratios (ORs) and the 95% confidence intervals (CIs) were estimated using Generalized Estimating Equation (GEE) with logistic specification to examine the independent effect of tapering policy and treatment duration on the probability of dose tapering, after controlling for age, sex, and index advanced therapy.Figure 1.Flow chart of patient selection:Results:The study comprised 9,094 patients initiated advance treatment for RA, with mean age of 57.3 (SD 13.3) years and 78.8% were female. The median PDC dropped remarkably after 28 months since treatment initiation (Figure 2). Probability of dose tapering increased significantly when treatment duration ≥24-month (OR=2.73,p<0.001). When treatment duration < 24-month, Dose Tapering policy was not significantly associated with tapering prescription. However, implementation of the policy further increased the probability of dose tapering for patients with treatment duration ≥ 24-month, OR for interaction of policy by duration was 1.17, and test for interactionp=0.014. There were about 3 times increase in the odds of dose tapering probability for patient treated longer than 24 months after the policy implemented in April 2014.Figure 2.The change of PDC of advanced therapy over the treatment periodConclusion:For RA patients, PDC of advanced therapy dropped notably after patients received advanced therapy for more than 24 months. The tapering policy implementation significantly increased the probability of dose tapering of advanced therapy in patients with treatment duration ≥ 24 months.References:[1]Lenert A, Lenert P. Clin Rheumatol. 2017;36(1):1-8.[2]Smolen JS, et al. Ann Rheum Dis. 2017;76(6):960-977.Table 1.effect of treatment duration and dose tapering policy on the probability of dose taperingOdds ratio95%CIp valueEffect of Treatment Duration (in pre-policy period)≥24-month vs <24-month2.73(2.45,3.05)<.001Effect of Dose Tapering policy (in treatment duration <24 months)Post-policy*vs Pre-policy0.94(0.87,1.01)0.110Interaction of Treatment Duration by Dose Tapering policy≥24-month x Post-policy1.17(1.03,1.32)0.014*Dose Tapering policy was implemented on April 1st, 2014Acknowledgments :Research is sponsored by Pfizer Ltd.Disclosure of Interests:Chao-Hsiun Tang: None declared, Chia-Li Chang: None declared, Wen-Yi Shau Employee of: Pfizer, Chih-Yi Hsin Employee of: Pfizer, Ko-Jen Li Speakers bureau: Speaker fee from Pfizer, Abbvie, Roche, Bristol-Myers Squibb, Eli Lilly and Johnson & Johnson

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Faculty Opinions recommendation of Ability of disease-modifying antirheumatic drugs to prevent or delay rheumatoid arthritis onset: a systematic literature review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733424519.793564294 ◽

2019 ◽

Author(s):

Ladislav Senolt

Keyword(s):

Rheumatoid Arthritis ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Disease Modifying

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FRI0526 THE INCIDENCE, PREVALENCE AND MEDICATION USE OF RHEUMATOID ARTHRITIS AMONG KOREAN WOMEN IN CHILDBEARING YEARS: A NATIONWIDE POPULATION-BASED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4249 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 862.2-863

Author(s):

M. K. Chung ◽

J. S. Park ◽

H. S. Lim ◽

C. H. Lee ◽

J. Lee

Keyword(s):

Rheumatoid Arthritis ◽

Lupus Erythematosus ◽

Medication Use ◽

Population Based ◽

Korean Women ◽

Childbearing Age ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Disease Modifying ◽

Incidence Prevalence

Background:Rheumatoid arthritis (RA) predominantly affects women and has a significant impact on childbearing. Several population-based studies identifying incidence, prevalence, and medication use of RA have been reported, yet epidemiological studies focusing on women with RA in childbearing years are missing.Objectives:We aimed to identify the incidence, prevalence and medication use of RA among Korean women in childbearing years.Methods:From National Health Insurance Service (NHIS) data (2009-2016), containing inpatient and outpatient claim information for approximately 97% of the Korean population, we identified 9,217,139 women aged between 20-44 years. Incidence and prevalence of RA in the specific sociodemographic group of women in childbearing age were analyzed, and the prevalence of medication prescription were compared between women with RA and controls without rheumatic diseases such as RA, systemic lupus erythematosus, and ankylosing spondylitis. Individuals with RA were defined by the presence of International Classification of Disease, 10th revision code, M05. The medication use was defined as receiving > 90days prescriptions of NSAIDs, corticosteroids (CSs), and conventional synthetic (cs) disease modifying antirheumatic drugs (DMARDs) or > 1day prescription of biologic (b) DMARDs.Results:Total 24,590 women with RA were identified. The average incidence of RA during 2011-2016 among women in childbearing years was 24.1/100,000 person-years (PYs) (95% CI 20.91-27.31) with a yearly increase from 20.99/100,000 PYs in 2011 to 28.38/100,000 PYs in 2016. The average prevalence of RA during 2009-2016 among women in childbearing years was 105.2/100,000 PYs (95% CI 99.0-111.5) with a minimum of 95.7/100,000 PYs in 2009 and a maximum of 110.5/100,000 PYs in 2016. There were increasing trends in both incidence and prevalence of RA according to age among women in childbearing years peaking in the age group of 40-44 years. The prescriptions of NSAIDs, CSs, csDMARDs and bDMARDs were more frequent in women with RA than controls (NSAIDs; 94.21% vs 21.79%, CSs; 83.65% vs 4.28%, csDMARDs; 91.23% vs 0.41%, bDMARDs; 0.11% vs 0%, p<0.001).Conclusion:The incidence and prevalence of RA are high among Korean women in childbearing years, and medication use was significantly more frequent in this specific population than controls. High disease burden is imposed upon women in childbearing years.References:[1] Won S, Cho SK, Kim D, Han M, Lee J, Jang EJ, Sung YK, Bae SC: Update on the prevalence and incidence of rheumatoid arthritis in Korea and an analysis of medical care and drug utilization. Rheumatol Int 2018, 38(4):649-656.[2] Smeele HTW, Dolhain R: Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Seminars in arthritis and rheumatism 2019, 49(3s):S32-s35.Table 1.Medication use among women with RA and controls in childbearing age between 20-44 years during 2009-2016Control(n=155,486)RA(n=23,756)n(%)n(%)PNSAIDs33,887(21.79)22,380(94.21)<.0001Steroids6,653(4.28)19,871(83.65)<.0001csDMARDs634(0.41)21,673(91.23)<.0001bDMARDs0(0.00)27(0.11)<.0001RA, rheumatoid arthritis; NSAID, non-steroidal anti-inflammatory drug; cs, conventional synthetic; b, biologic; DMARDs, disease modifying antirheumatic drugsDisclosure of Interests:None declared

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FRI0024 Effectiveness and toxicity profiles of traditional disease modifying antirheumatic drugs for rheumatoid arthritis

10.1136/annrheumdis-2001.1153 ◽

2001 ◽

Author(s):

D Aletaha ◽

JS Smolen

Keyword(s):

Rheumatoid Arthritis ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Disease Modifying

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Hyperlipidemia Is a Risk Factor of Adhesive Capsulitis: Real-World Evidence Using the Taiwanese National Health Insurance Research Database

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120986808 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712098680

Author(s):

Jr-Yi Wang ◽

Chen-Kun Liaw ◽

Chi-Chang Huang ◽

Tsan-Hon Liou ◽

Hui-Wen Lin ◽

...

Keyword(s):

Risk Factor ◽

Health Insurance ◽

Propensity Score ◽

National Health Insurance ◽

National Health ◽

Glenohumeral Joint ◽

Adhesive Capsulitis ◽

Small Sample ◽

Research Database ◽

Statin Use

Background: Patients with adhesive capsulitis are evaluated for pain and progressive contracture of the glenohumeral joint. Whether endocrine, immune, or inflammatory processes are involved in its definite pathogenesis is still under debate. Some cross-sectional studies with a small sample size have noted that hyperlipidemia is a possible risk factor for frozen shoulders. Purpose/Hypothesis: The purpose was to conduct a longitudinal population-based study to investigate the risk of adhesive capsulitis among patients with hyperlipidemia. It was hypothesized that patients with hyperlipidemia would have a higher risk of adhesive capsulitis and that the use of statin drugs could reduce the rate. Study Design: Cohort study; Level of evidence, 3. Methods: Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, the authors obtained the records of patients with hyperlipidemia who received a diagnosis between 2004 and 2005 and were followed up until the end of 2010. The control cohort comprised age- and sex-matched patients without hyperlipidemia. Propensity score matching was performed for the other comorbidities. A Cox multivariate proportional hazards model was applied to analyze the risk factors of adhesive capsulitis. The hazard ratio (HR) and adjusted HR were estimated between the study and control cohorts after adjustment for confounders. The effects of statin use on adhesive capsulitis risk were also analyzed. Results: The NHIRD records of 28,748 patients and 114,992 propensity score–matched controls were evaluated. A higher incidence rate of adhesive capsulitis was revealed in the hyperlipidemia cohort, with a crude HR of 1.70 (95% CI, 1.61-1.79; P < .001) and adjusted HR of 1.50 (95% CI, 1.41-1.59; P < .001). Patients with hyperlipidemia who used a statin still had higher crude and adjusted HRs compared with controls. Statin use did not exert protective effects on patients with hyperlipidemia. Conclusion: Patients with hyperlipidemia had a 1.5-fold higher risk of adhesive capsulitis than did healthy controls. Statin use did not provide protection against adhesive capsulitis in patients with hyperlipidemia.

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