背景:这项研究比较了从肿瘤坏死因子抑制剂(TNFi)转换为upadacitinib(TNFi-UPA)的临床有效性,另一个TNFi(TNFi-TNFi),或类风湿关节炎(RA)患者的另一种作用机制(TNFi-其他MOA)的高级疗法。
方法:数据来自AdelphiRA疾病特定计划™,一项针对德国风湿病学家及其咨询患者的横断面调查,法国,意大利,西班牙,英国,Japan,加拿大,和美国从2021年5月到2022年1月。从初始TNFi切换治疗的患者通过后续感兴趣的治疗进行分层:TNFi-UPA,TNFi-TNFi,或TNFi-其他MOA。医生报告的临床结果,包括疾病活动(29%的患者可获得正式的DAS28评分)归类为缓解,低/中/高疾病活动,以及在当前治疗开始时和治疗切换后≥6个月时记录的疼痛.从治疗切换后≥6个月测量疲劳和治疗依从性。逆概率加权回归调整比较了后续治疗类别的结果:TNFi-UPA与TNFi-TNFi,或TNFi-UPA与TNFi-其他MOA。
结果:在503名从第一次TNFi切换的患者中,261在TNFi-UPA,128英寸TNFi-TNFi,和114在TNFi-其他MOA组中。在转换的时候,大多数患者有中度/高度疾病活动(TNFi-UPA:73%;TNFi-TNFi:52%;TNFi-其他MOA:60%).调整开关点的特性差异后,TNFi-UPA组(n=261)患者更有可能达到医生报告的缓解(67.7%vs.40.3%;p=0.0015),无痛(55.7%vs.25.4%;p=0.0007),和完全依从性(60.0%vs.与TNFi-TNFi组患者(n=121)相比,为34.2%;p=0.0049)。对于TNFi-UPA与TNFi-其他MOA组观察到类似的发现(n=111)。
结论:从TNFi转换为UPA的患者具有明显更好的临床缓解结果,没有疼痛,和完全坚持比那些循环TNFi或切换到另一个MOA。
BACKGROUND: This study compared the clinical effectiveness of switching from tumor necrosis factor inhibitor (TNFi) to upadacitinib (TNFi-UPA), another TNFi (TNFi-TNFi), or an advanced therapy with another mechanism of action (TNFi-other MOA) in patients with rheumatoid arthritis (RA).
METHODS: Data were drawn from the Adelphi RA Disease Specific Programme™, a cross-sectional survey administered to rheumatologists and their consulting patients in Germany, France, Italy, Spain, the UK, Japan, Canada, and the USA from May 2021 to January 2022. Patients who switched treatment from an initial TNFi were stratified by subsequent therapy of interest: TNFi-UPA, TNFi-TNFi, or TNFi-other MOA. Physician-reported clinical outcomes including disease activity (with formal DAS28 scoring available for 29% of patients) categorized as remission, low/moderate/high disease activity, as well as pain were recorded at initiation of current treatment and ≥ 6 months from treatment switch. Fatigue and treatment adherence were measured ≥ 6 months from treatment switch. Inverse-probability-weighted regression adjustment compared outcomes by subsequent class of therapy: TNFi-UPA versus TNFi-TNFi, or TNFi-UPA versus TNFi-other MOA.
RESULTS: Of 503 patients who switched from their first TNFi, 261 were in TNFi-UPA, 128 in TNFi-TNFi, and 114 in TNFi-other MOA groups. At the time of switch, most patients had moderate/high disease activity (TNFi-UPA: 73%; TNFi-TNFi: 52%; TNFi-other MOA: 60%). After adjustment for differences in characteristics at point of switch, patients in TNFi-UPA group (n = 261) were significantly more likely to achieve physician-reported remission (67.7% vs. 40.3%; p = 0.0015), no pain (55.7% vs. 25.4%; p = 0.0007), and complete adherence (60.0% vs. 34.2%; p = 0.0049) compared with patients in TNFi-TNFi group (n = 121). Similar findings were observed for TNFi-UPA versus TNFi-other MOA groups (n = 111).
CONCLUSIONS: Patients who switched from TNFi to UPA had significantly better clinical outcomes of remission, no pain, and complete adherence than those who cycled TNFi or switched to another MOA.