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A European chart review study on early rheumatoid arthritis treatment patterns, clinical outcomes, and healthcare utilization

  • Original Article - Observational Research
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Abstract

This retrospective medical chart review aimed to provide a current, real-world overview of biologic usage in patients with rheumatoid arthritis (RA) in Germany, Spain, and the UK, and estimate clinical and healthcare utilization outcomes associated with early versus late treatment. Adults (≥18 years) with a confirmed RA diagnosis between January 2008 and December 2010, who received biologic treatment for ≥3 months and had ≥12 months of follow-up were included. Early treatment was receipt of biologic agent ≤1 year after RA diagnosis. Outcomes included 28-joint disease activity score (DAS28) reduction of ≥1.2 from biologic start and remission (DAS28 < 2.6). Time to outcome was evaluated using Kaplan–Meier curves and log-rank tests. Of 328 patients enrolled (Germany [n = 111], Spain [n = 106], UK [n = 111]), 58.2 % received early biologic (Germany: 55.0 %, UK: 55.9 %, Spain: 64.2 %; p = 0.321). First-line biologics were more frequent in Spain (26.4 %) and Germany (19.8 %) versus the UK (7.2 %; p < 0.001). Late-treated patients were hospitalized more often than early-treated patients (10.5 vs 2.9 % [p = 0.006] for 9.0 vs 5.4 mean inpatient days [p = 0.408]). DAS28 was 5.1 at biologic initiation (n = 310); 73.5 % of patients had a DAS28 decrease of ≥1.2 and 44.5 % achieved remission. More patients had DAS28 decrease of ≥1.2 (79.2 vs 65.9 %; p = 0.009) and remission (51.1 vs 35.6 %; p = 0.007) with early versus late treatment, with a significant difference in Kaplan–Meier curves when indexing on time since diagnosis (p < 0.001) and biologic start (p = 0.024). In RA patients receiving biologic therapy, over half received biologic therapy early. Early initiation was associated with improved clinical outcomes and reduced hospitalization rates versus late treatment.

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Acknowledgments

The authors would like to thank Maria Echave (Pfizer Spain, Madrid, Spain), Joscha Gussmann (Pfizer Germany, Berlin, Germany), and Michal Kantecki (Pfizer International Operations, Paris, France) for their valuable contributions. The authors would also like to thank research team members of Pharmerit International: Jennifer Stephens, Marja Hensen, Shelby Corman, and Medical Data Analytics: Cynthia Macahilig for their contributions to study design, data collection, analysis, and reporting throughout the project. The authors and sponsor were involved in the study design, data interpretation, manuscript development, and decision to publish. All data analyses were performed by Pharmerit International and Medical Data Analytics, Europe, and USA. All authors had full access to the data and had final responsibility for the decision to submit the manuscript for publication. Editorial/medical writing support was provided by Samantha Forster of Engage Scientific Solutions and was funded by Pfizer Inc.

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Authors and Affiliations

  1. Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Chapeltown Road, Leeds, LS7 4SA, UK

    Paul Emery

  2. NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS2 9PH, UK

    Paul Emery

  3. Pharmerit International, Bethesda, MD, USA

    Caitlyn Solem

  4. Pharmerit International, Rotterdam, The Netherlands

    Istvan Majer

  5. Pfizer Inc., Groton, CT, USA

    Joseph C. Cappelleri

  6. Pfizer Italia, Rome, Italy

    Miriam Tarallo

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Correspondence to Paul Emery.

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PE has received honorarium and consulting fees for BMS, Roche, Chugai, MSD, Pfizer, AbbVie, Novartis, and UCB. CS and IM are full-time employees of Pharmerit International, contracted by Pfizer Inc, to conduct this research. JCC and MT are full-time employees of Pfizer Inc.

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Emery, P., Solem, C., Majer, I. et al. A European chart review study on early rheumatoid arthritis treatment patterns, clinical outcomes, and healthcare utilization. Rheumatol Int 35, 1837–1849 (2015). https://doi.org/10.1007/s00296-015-3312-3

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