| Summary: | 碩士 === 國立成功大學 === 臨床藥學與藥物科技研究所 === 101 === Background
Rheumatoid arthritis (RA) is a chronic inflammatory condition affecting the joints most. When untreated, RA causes pain, continuing joints damage and deformity, disability, and premature mortality in most patients. RA also increases disease morbidity and mortality, especially cardiovascular disease, infection and osteoporosis. Early initiation and timely escalation of treatment with conventional disease-modifying anti-rheumatic drugs(DMARDs) and the initiation of treatment with biologic DMARDs can significantly improve the prognosis. For now, RA can’t be cured and disease activity is thought to be related to radiologic progression. The goal of treatment is to achieve a state of clinical remission or low disease activity. However, little is known of the extent to which treatment options and strategies have entered routine care in Taiwan. Therefore, this study was aimed to investigate the prescribing pattern of DMARDs in established RA patients and the changes in patterns of DMARDs utilization.
Methods
We conducted a cross-sectional study by using 2001-2010 Taiwan’s National Health Insurance Research Database. We identified patients who was issued a catastrophic illness certificate for RA (ICD code: 7140) for the first time during the period from January 1, 2002 through December 31, 2009 and patients must fulfill the 1987 ACR criteria. We estimated DMARDs utilization using cross-sectional assessments and defined the date of application for catastrophic illness certificate as index date, and observed DMARDs prescribing patterns at different time point after the index date. In addiction, if patients started their first TNF-α inhibitors prescription after the first year of the index date, we analyzed how TNF-α inhibitors were being used in clinical practice.
Results
During the study period, we identified 21,196 patients with RA. The mean age was 54 years; the average proportion of female patients was 77.4%. Approximately, 82.5% of RA patients received DMARDs on the index date. The proportion of patients without DMARDs prescription on the index date decreased from 22.1% in 2002 to 13% in 2009. A continuous increase in combination DMARDs therapy and a decrease in monotherapy were observed. 51.6% of RA patients were co-prescribing oral steroids.
Hydroxychloroquine, sulfasalazine, methotrexate were the three most prescribed DMARDs. At different observed time point, the utilization of methotrexate had a trend to surpass the utilization of sulfasalazine and hydroxychloroquine during the study period. At the first year after the index date, the use of TNF-α inhibitors increased from 0.1% of patients in 2002 to 7.6% in 2009. The percentage of patients initiated on TNF-α inhibitors in combination with any conventional DMARDs was 84%, while combination with methotrexate was about 74%.
Conclusions
This study showed the utilization of DMARDs increased in Taiwan with RA, especially combination therapy including methotrexate. Overall, there was a trend toward more aggressive management of RA in Taiwan and in accordance with international trends.
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