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Comparative effectiveness of treatment options after conventional DMARDs failure in rheumatoid arthritis

Title
Comparative effectiveness of treatment options after conventional DMARDs failure in rheumatoid arthritis
Authors
Sung Y.-K.Cho S.-K.Kim D.Choi C.-B.Won S.Bang S.-Y.Cha H.-S.Choe J.-Y.Chung W.T.Hong S.-J.Jun J.-B.Kim H.A.Kim J.Kim S.-K.Kim T.-H.Lee H.-S.Lee J.Lee S.-S.Lee S.W.Lee Y.-A.Nah S.-S.Suh C.-H.Yoo D.-H.Yoon B.Y.Bae S.C.For the BIOPSY and KORONA investigators
Ewha Authors
이지수
SCOPUS Author ID
이지수scopus
Issue Date
2017
Journal Title
Rheumatology International
ISSN
0172-8172JCR Link
Citation
vol. 37, no. 6, pp. 975 - 982
Keywords
Anti-TNF drugsDMARDsHAQQuality of lifeRheumatoid arthritis
Publisher
Springer Verlag
Indexed
SCI; SCIE; SCOPUS WOS scopus
Abstract
Objective: To compare the clinical effectiveness of two treatment strategies for active rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs): starting TNF inhibitors (TNFIs) or changing csDMARDs. Methods: We used two nationwide Korean RA registries for patient selection. TNFI users were selected from the BIOPSY, which is an inception cohort of RA patients starting biologic DMARDs. As a control group, we selected RA patients with moderate or high disease activity from the KORONA database whose treatment was changed to other csDMARDs. After comparing baseline characteristics between the two groups in either unmatched or propensity score matched cohorts, we compared potential differences in the 1-year remission rate as a primary outcome and changes in HAQ-DI and EQ-5D scores as secondary outcomes. Results: A total of 356 TNFI starters and 586 csDMARD changers were identified from each registry as unmatched cohorts, and 294 patients were included in the propensity score matched cohort. In the intention-to-treat analysis, TNFI starters had higher 1-year remission rates than csDMARD changers in both unmatched (19.1 vs. 18.4%, p < 0.01) and matched cohorts (19.7 vs. 15.0%, p < 0.01). In per protocol analysis, TNFI starters had much higher remission rates in unmatched (37.2 vs. 28.0%, p = 0.04) and matched cohorts (35.4 vs. 19.1%, p = 0.04). However, in matched cohorts, no significant differences were observed between two groups in HAQ-DI and EQ-5D scores. Conclusions: We compared the clinical effectiveness of the two treatment strategies for active RA refractory to csDMARDs. TNFI starters showed higher 1-year remission rates than csDMARD changers. © 2017, Springer-Verlag Berlin Heidelberg.
DOI
10.1007/s00296-016-3649-2
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의학전문대학원 > 의학과 > Journal papers
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