Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort

octobre 11, 2017 | Posted by admin

Un nouvel article scientifique intitulé «Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort.» a été publié dans le journal J Rheumatol.

Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis AH.

Abstract

OBJECTIVE:

To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indifférenciées Récentes).

METHODS:

Using alternate definitions of adherence, patients were classified as adherent « timely » anti-TNF users, nonadherent « late » anti-TNF users, adherent nonusers ( »no anti-TNF need »), non-adherent nonusers ( »unmet anti-TNF need »). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a γ-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes.

RESULTS:

Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54-1.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44-1.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06-2.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (-0.04, 95% CI -0.07 to -0.01, p = 0.016).

CONCLUSION:

The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.

KEYWORDS:

ADHERENCE; ANKYLOSING SPONDYLITIS; ANTI-TNF; ECONOMIC; QUALITY OF LIFE; SPONDYLOARTHRITIS

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