不同国家的RA患者启用TNF抑制剂存在差异

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Semin Arthritis Rheum. 2010 Dec 16. [Epub ahead of print] Comparison of Anti-TNF Treatment Initiation in Rheumatoid Arthritis Databases Demonstrates Wide Country Variability in Patient Parameters at Initiation of Anti-TNF Therapy. Pease C, Pope JE, Truong D, Bombardier C, Widdifield J, Thorne JC, Paul Haraoui B, Psaradellis E, Sampalis J, Bonner A. Department of Medicine, University of Western Ontario, London, ON, Canada. Abstract OBJECTIVE: Characteristics of Canadian RA patients started on anti-tumor necrosis factor (TNF) treatment were compared with 12 other countries. METHODS: Data from the Optimization of HUMIRA trial (OH) were compared with Canadian real world studies [Ontario Biologics Research Initiative (OBRI) and the Real-Life Evaluation of Rheumatoid Arthritis in Canadians Receiving HUMIRA (REACH) ], and to data from American, Australian, British, Czech, Danish, Dutch, Finnish, German, Italian, Norwegian, Spanish, and Swedish RA databases. Patient characteristics and temporal trends at initiation of anti-TNF therapy were compared between countries. RESULTS: Baseline Disease Activity Scores (DAS28) varied from 5.3 to 6.6. Lower disease severity was noted in databases from countries with less restrictive anti-TNF coverage: Dutch [based on previous disease-modifying antirheumatic drugs (DMARD) use, DAS28, swollen joint count (SJC), tender joint count (TJC), Health Assessment Questionnaire Disability Index (HAQ-DI), Danish (previous DMARD use, DAS28), Norwegian (DAS28, SJC, TJC, visual analog scale (VAS) of global health), and Swedish (DAS28, SJC, TJC, HAQ-DI)]. RA databases showed lower disease scores than did OH (P < 0.05). The US databases also showed lower disease severity (CORRONA: previous DMARD use, SJC, TJC; National Data Bank for Rheumatic Diseases: HAQ, P < 0.001). The UK and Czech Republic had restrictive coverage and higher mean baseline DAS28 than OH (P < 0.001). Baseline DAS28 in the registries with published data lowered over time (British, Norwegian, Danish, and Swedish) but less for the British (P < 0.001). CONCLUSIONS: These results confirm that regional variation exists between the 13 countries analyzed in the initiation of treatment with anti-TNF agents among RA patients and suggest that in some cases this variation may be increasing. In some countries the mean baseline disease severity declined over time and regional reimbursement policies and differences in physician preferences may be influencing initiation of anti-TNF therapy in RA.

不同国家的RA患者启用TNF抑制剂存在差异 Pease C,et al.Semin Arthritis Rheum. 2010 Dec 16.   目的：开始使用TNF抑制剂的加拿大RA患者与其他12个国家患者进行比较。   方法：将HUMIRA优化试验（OH）的数据与加拿大现实临床研究（安大略生物制剂研究倡议[OBRI]和HUMIRA加拿大类风湿关节炎现实评估[REACH]）进行比较，并与美国、澳大利亚、英国、捷克、丹麦、荷兰、芬兰、德国、意大利、挪威、西班牙和瑞典RA数据库进行比较。比较不同国家的患者特征和启用TNF抑制剂的暂时趋势。   结果：基线期DAS28为5.3-6.6。在TNF抑制剂覆盖度限制不严格的国家，疾病活动度较低：荷兰（根据之前DMARDs的使用情况、DAS28、肿胀关节数[SJC]、压痛关节数[TJC]、健康评估问卷残疾指数[HAQ-DI]）、丹麦（之前DMARDs的使用情况、DAS28）、挪威（DAS28、SJC、TJC、总体健康状况VAS）和瑞典（DAS28、SJC、TJC、HAQ-DI）。RA数据库的疾病评分低于OH（P < 0.05）。美国数据库也显示疾病活动度较低（CORRONA: 之前DMARDs的使用情况、SJC、TJC；风湿性疾病国家数据库：HAQ，P < 0.001)）。英国和捷克共和国TNF抑制剂的覆盖度限制较为严格，平均基线期DAS28高于OH（P < 0.001）。在注册中心已发表的数据中，基线期DAS28随时间降低（英国、挪威、丹麦和瑞典），但英国降低度较小（P < 0.001）。   结论:结果证实13个国家的RA患者启用TNF抑制剂存在地域差异，在部分病例中，这种差异可能更大。部分国家的平均基线期疾病活动度随时间而降低，地区报销政策和医师选择偏好可能对RA患者启用TNF抑制剂产生影响。