目的：

        本研究的目的是1)描述和比较瑞典强直性脊柱炎(AS)，银屑病关节炎(PsA)或类风湿关节炎(RA)(统称为免疫介导的风湿病)患者一线和二线皮下给药肿瘤坏死因子-α抑制剂(SC-TNFis)的治疗依从性，以及2)评估和比较两组(一线和二线治疗)患者的治疗费用。

        方法：

        根据处方药登记记录，从2010年5月6日至2012年12月12日期间一线使用或二线使用SC-TNFi的患者被纳入研究。使用生存分析估计用药依从性。治疗成本包括特殊门诊护理、住院护理和药物治疗。依从性分析是按照免疫介导风湿病的诊断来分层进行的。

        结果：

        总共有4,903例患者一线使用SC-TNFi治疗，845例患者二线使用SC-TNFi治疗。两组之间的基线特征不同。因此，我们进行了倾向评分的匹配分析。对二线用药与一线用药患者进行匹配，产生了四组队列(AS，PsA，RA和所有疾病诊断)。一线使用SC-TNFi治疗的患者依从性显著高于二线使用的患者，在PsA(P = 0.036)，RA(P = 0.048)和所有疾病诊断组(P <0.001)均有统计学显著差异，但AS组例外(P = 0.741)。二线使用SC-TNFi治疗的患者比一线使用SC-TNFi治疗的患者治疗费用更高。

        结论：

        总体而言，一线使用SC-TNFi的依从性高于二线使用SC-TNFi。此外，二线使用SC-TNFi比一线使用SC-TNFi治疗成本更高。因此，一线处方SC-TNFi，对于获得最佳的长期依从性可能是有益的。

        原文

Persistence and costs with subcutaneous TNF-alpha inhibitors in immune-mediated rheumatic disease stratified by treatment line.

        Abstract

OBJECTIVES:

        The objectives of this study were to 1) describe and compare treatment persistence with first- and second-line subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) (collectively immune-mediated rheumatic disease) in Sweden and 2) estimate and contrast health care costs in the two groups.

METHODS:

        Patients who initiated their first or second SC-TNFi between May 6 2010 and December 12 2012 were identified from the Prescribed Drug Register. Persistence was estimated using survival analysis. Costs comprised specialized outpatient care, inpatient care, and medication. The persistence analysis was stratified by immune-mediated rheumatic disease diagnosis.

RESULTS:

        A total of 4,903 patients treated with their first and 845 patients treated with their second SC-TNFi were identified. Baseline characteristics differed between the two groups. Therefore, propensity score matching analysis was implemented. Second-line patients were matched to first-line patients, and four cohort pairs (AS, PsA, RA, and all diagnoses combined) were generated. Patients treated with their first SC-TNFi had statistically significant higher persistence than patients treated with their second SC-TNFi in PsA (P=0.036), RA (P=0.048), and all diagnoses combined (P<0.001) but not in AS (P=0.741). Patients who were treated with their second SC-TNFi incurred higher costs than patients treated with their first SC-TNFi.

CONCLUSIONS:

        Overall, persistence to the first SC-TNFi was higher than persistence to the second SC-TNFi. Furthermore, the second SC-TNFi was associated with higher costs than the first SC-TNFi. Therefore, prescribing the SC-TNFi with the best long-term persistence first may be beneficial.