bDMARDs在SpA中的应用具有显著差异
2017EULAR热点报道：世界范围bDMARDs在SpA中的应用具有显著差异
背景：
生物类抗风湿类药物（bDMARDs）在脊柱关节炎（SpA）中的价值的得到了越来越多重视，但由于经济等因素，bDMARDs在世界范围应用具有明显差异。
目的：
本研究探讨了不同国家和地区bDMARDs在SpA中的应用差异及社会经济因素与其相关性。
方法：
国际性横断面ASAS COMOSpA研究纳入符合ASAS SpA标准的病人。以当前国家bDMARDs的应用作为有随机截距的多水平Logistic回归模型的因变量。国家卫生支出与国内生产总值（GDP）对社会经济的贡献（低、中、高3组）作为国家水平独立影响因素，在模型中作为社会人口学因素与临床变量一起决定bDMARD在SpA中的应用。
结果：
共3370例来自22个国家的患者符合纳入标准（平均年龄：43岁；平均患病时间：14年；其中66%为男性；88%为中轴病变）。在这些国家中，共有1275例（38%）SpA患者为bDMARDs使用者。各国使用bDMARDs比例从5%（中国）到74%（比利时）不等。在调整相关社会人口和临床变量后，各国bDMARD使用的显著差距仍然存在（图1，p <0.001）。 各国的社会经济因素，尤其是较高的卫生支出与较高的bDMARD摄取有关（表1），虽然结果无统计学意义（OR 1.91; 95％CI 0.93,3.92）。 国家GDP水平也存在类似结果（OR 1.72; 95％CI 0.83,3.57）。
图1 不同国家bDMARDs的使用率（%），基于社会经济，社会人口和临床变量调整模型，百分比用量显示为95％CI
表1 国家社会经济因素对社会人口和临床变量调整模型中使用bDMARDs的影响（国家作为随机效应）
结论：
在排除了临床变量和国家间的社会因素后，各国国家间SpA患者的bDMARD使用率仍有巨大差异。
原文
INEQUITY IN BIOLOGIC DMARD PRESCRIPTION FOR SPA ACROSS THE GLOBE. RESULTS FROM THE ASAS COMOSPA STUDY.
E. Nikiphorou1,*, D. van der Heijde2, S. Norton1, R. Landewé3, A. Moltó4, M. Dougados4, F. van den Bosch5, S. Ramiro2
1KCL,London, United Kingdom, 2LUMC, Leiden, 3ARC, Amsterdam,Netherlands, 4Paris Descartes University, Paris, France, 5GhentUniversity Hospital, Ghent, Belgium
Background:
The value of biologic DMARDs (bDMARDs) in SpA is well recognized but global access to these treatments can be limited due to high cost and other factors.
Objectives:
This study explores variation in the use of bDMARDs in SpA across countries and to what extent socio-economic (SE) factors may explain variation.
Methods:
Patients fulfilling the ASAS SpA criteria in the multi-national, cross-sectional ASAS COMOSPA study were studied. Multi-level logistic regression models with random intercept for country were constructed with current use of bDMARDs as the dependent variable. Contribution of socio-economic factors using country health expenditures and gross domestic product (GDP) (all low vs medium/high tertiles) as independent country-level factors, was explored in models adjusted for socio-demographic as well as clinical variables known to determine bDMARD-use in SpA.
Results:
In total, 3370 patients from 22 countries were included (mean [SD] age 43 [14] years; 66% male; 88% axial disease). Across countries, 1275 (38%) were bDMARD users. Crude mean bDMARD-use varied between 5% (China) to 74% (Belgium). After adjustment for relevant socio-demographic and clinical variables, important variation in bDMARD-use across countries remained (Figure, p<0.001). Country-level socio-economic factors, specifically higher health expenditures were related to higher bDMARD uptake (Table), though not meeting statistical significance (OR 1.91; 95%CI 0.93,3.92). Similar findings were found with country GDP (OR 1.72;95%CI 0.83,3.57).
Image/graph:
Conclusions:
There remains important residual variation across countries in bDMARD uptake of patients with SpA followed in specialized SpA centers. This is despite adjustment of well-known factors for bDMARD use such as clinical and country-level socio-economic factors.
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