目的：

        本研究的目的是1)描述和比較瑞典強(qiáng)直性脊柱炎(AS)，銀屑病關(guān)節(jié)炎(PsA)或類風(fēng)濕關(guān)節(jié)炎(RA)(統(tǒng)稱為免疫介導(dǎo)的風(fēng)濕病)患者一線和二線皮下給藥腫瘤壞死因子-α抑制劑(SC-TNFis)的治療依從性,，以及2)評估和比較兩組(一線和二線治療)患者的治療費(fèi)用,。

        方法：

        根據(jù)處方藥登記記錄，從2010年5月6日至2012年12月12日期間一線使用或二線使用SC-TNFi的患者被納入研究,。使用生存分析估計(jì)用藥依從性,。治療成本包括特殊門診護(hù)理、住院護(hù)理和藥物治療,。依從性分析是按照免疫介導(dǎo)風(fēng)濕病的診斷來分層進(jìn)行的,。

        結(jié)果：

        總共有4,903例患者一線使用SC-TNFi治療，845例患者二線使用SC-TNFi治療,。兩組之間的基線特征不同,。因此,，我們進(jìn)行了傾向評分的匹配分析,。對二線用藥與一線用藥患者進(jìn)行匹配，產(chǎn)生了四組隊(duì)列(AS,，PsA,，RA和所有疾病診斷)。一線使用SC-TNFi治療的患者依從性顯著高于二線使用的患者,，在PsA(P = 0.036),，RA(P = 0.048)和所有疾病診斷組(P <0.001)均有統(tǒng)計(jì)學(xué)顯著差異，但AS組例外(P = 0.741),。二線使用SC-TNFi治療的患者比一線使用SC-TNFi治療的患者治療費(fèi)用更高,。

        結(jié)論：

        總體而言，一線使用SC-TNFi的依從性高于二線使用SC-TNFi,。此外,，二線使用SC-TNFi比一線使用SC-TNFi治療成本更高。因此,，一線處方SC-TNFi,，對于獲得最佳的長期依從性可能是有益的。

        原文

Persistence and costs with subcutaneous TNF-alpha inhibitors in immune-mediated rheumatic disease stratified by treatment line.

        Abstract

OBJECTIVES:

        The objectives of this study were to 1) describe and compare treatment persistence with first- and second-line subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) (collectively immune-mediated rheumatic disease) in Sweden and 2) estimate and contrast health care costs in the two groups.

METHODS:

        Patients who initiated their first or second SC-TNFi between May 6 2010 and December 12 2012 were identified from the Prescribed Drug Register. Persistence was estimated using survival analysis. Costs comprised specialized outpatient care, inpatient care, and medication. The persistence analysis was stratified by immune-mediated rheumatic disease diagnosis.

RESULTS:

        A total of 4,903 patients treated with their first and 845 patients treated with their second SC-TNFi were identified. baseline characteristics differed between the two groups. Therefore, propensity score matching analysis was implemented. Second-line patients were matched to first-line patients, and four cohort pairs (AS, PsA, RA, and all diagnoses combined) were generated. Patients treated with their first SC-TNFi had statistically significant higher persistence than patients treated with their second SC-TNFi in PsA (P=0.036), RA (P=0.048), and all diagnoses combined (P<0.001) but not in AS (P=0.741). Patients who were treated with their second SC-TNFi incurred higher costs than patients treated with their first SC-TNFi.

CONCLUSIONS:

        Overall, persistence to the first SC-TNFi was higher than persistence to the second SC-TNFi. Furthermore, the second SC-TNFi was associated with higher costs than the first SC-TNFi. Therefore, prescribing the SC-TNFi with the best long-term persistence first may be beneficial.