生物制剂应用20150604.ppt

* Objectives: To determine medication trends in rheumatoid arthritis patients over the past 7 years using a large observational US data bank. Methods: Participants were members of the US National Data Bank for Rheumatic Diseases longitudinal study of rheumatic disease outcomes. Between July 1998 and June 2005, we followed 10,982 RA patients (23.5% male, average initial age and disease duration of 59.5 and 12.9 years respectively) who were enrolled in the data bank by 411 community rheumatologists. Patients represented ordinary clinical practice and were not recruited as part of treatment or safety registries. Medication type, dose and frequency used were collected at 6-month intervals. Results: The use of DMARDs was consistent over time at 82% with methotrexate (MTX) being the modal therapy (52%) (Table 1). Hydroxychloroquine was the second most common DMARD though its use declined from 29% to 20%. Leflunomide increased to 11% in 2001 and returned to 9% in 2005, consistent with most non-biologics’ decrease (sulfasalazine 11% to 6%, gold injection 5% to 1%, all others 2%). For the biologics, etanercept plateaued at 15% in 2001 when there was a supply shortage. Infliximab peaked over 20% in 2003 and has decreased to 18% while adalimumab has increased to 8%. Anakinra peaked at 1.3% in 2002. While the number of simultaneous DMARDs increased from 1.1 to 1.3 per patient, this was primarily due to the addition of a biologic as “triple therapy” (MTX, hydroxychloroquine and sulfasalazine) use remained near 1.6% throughout. At any time 67% were taking an NSAID on average while Cox-2 use peaked in 2001 at 29% and is now at 14%. Rofecoxib peaked at 11.5% and is now 0%, valdecoxib peaked at 5.2% in 2004 and now is 1.8% and celecoxib peaked at 18% in 2001 and now is 12%. GI drug use averaged at 38%, though PPI use increased to 19%. Analgesic use remained at 38% though opiods, its subset, increased over time to 18%. Prednisone use decreased until 2003 where it stayed at 27%. D