Artikel
Treatment failure, treatment switching and health-related quality of life in patients with ankylosing spondylitis or psoriatic arthritis: results from a large multinational realworld sample in Europe and the USA
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Autoren
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Rieke H.-E. Alten
- Schlossparkklinik, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Innere Medizin II, Rheumatologie, klinische Immunologie und Osteologie, Berlin
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Emma Sullivan
- Adelphi Real World, Manchester, Großbritannien
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Stuart Blackburn
- Adelphi Real World, Manchester, Großbritannien
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Haijun Tian
- Novartis Pharmaceuticals Corporation, East Hanover, USA
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Kunal Gandhi
- Novartis Pharmaceuticals Corporation, East Hanover, USA
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Steffen Jugl
- Novartis Pharma AG, Basel, Schweiz
| Veröffentlicht: | 29. August 2016 |
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Gliederung
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Background: Many patients with AS or PsA do not receive AT (biologics or apremilast) or their first experience of AT is inadequate owing to lack of efficacy, intolerance or loss of benefit.
Objectives: To describe use of AT, treatment failure and switching, and assess implications of failure.
Methods: In this cross-sectional survey physicians with 3–30 years’ experience were eligible. Physician-completed record forms included reasons for switching AT (PLE [initial non-response]; SLE [loss of response over time]). Patients reported HRQoL (EQ-5D and SF-36), WPAI and HAQ-DI (PsA only). Current AT was assessed as ‘failed’ if, after ≥3 months, disease severity had worsened or remained, or if the physician was dissatisfied with disease control.
Results: Data are presented from 599 physicians (AS patients 2018; PsA patients 2436). Of 1889 AS patients (full treatment data), 33.5% had never received AT, 57.1% were receiving their first, 6.9% their second and 2.5% their third or later. Of the 2278 PsA patients (full treatment data), the proportions were 40.8%, 48.0%, 7.9% and 3.2%. 190 AS and 245 PsA patients switched from first AT (PLE: 15.8%, 22.0%; SLE: 46.8%, 44,9%). Despite PLE, patients continued on first-line AT for a mean 12.1 months (AS, n=30) and 9.5 months (PsA, n=52). The ‘failure’ rate increased with successive ATs: 10.8% of AS and 11.0% of PsA patients (first AT), 16.2% and 13.3% (second) and 22.9% and 19.2% (third).
AS patients failing AT had significantly worse EQ-5D utilities (0.55 vs 0.82) and SF-36: PCS (45.9 vs 73.3), MCS (57.5 vs 69.6) and SF (53.8 vs 75.2) scores (all p<0.0001). PsA patients failing AT also had significantly worse EQ-5D (0.63 vs 0.80, p<0.0001), PCS (55.1 vs 73.9, p<0.0001), MCS (60.4 vs 67.9, p=0.0024) and SF (60.4 vs 75.0, p<0.0001) scores. For AS-failure, WPAI (44.0% vs 21.7%, p<0.0001) was higher, and for PsA-failure, WPAI (29.7% vs 21.0%, p=0.0112) and HAQ-DI (0.96 vs 0.55, p<0.0001) were higher than non-failure.
Figure 1 [Fig. 1]
Conclusion: This large multinational survey in AS and PsA showed that the main reason for switching AT is lack of efficacy. Failure of AT has significant negative effects on HRQoL and work productivity.
