Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://dx.doi.org/10.1136/bmjopen-2018-027059 http://hdl.handle.net/1843/61168 |
Resumo: | Objectives: To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design: Retrospective cohort. Setting: Patients in secondary care receiving SC biologics in the largest Scottish Health Board. Participants: A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. Outcomes measured: A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR). Results: 751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days’ follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%). Conclusion: Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies. |
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2023-11-20T22:11:49Z2023-11-20T22:11:49Z2019-0999111http://dx.doi.org/10.1136/bmjopen-2018-0270592044-6055http://hdl.handle.net/1843/61168Objectives: To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design: Retrospective cohort. Setting: Patients in secondary care receiving SC biologics in the largest Scottish Health Board. Participants: A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. Outcomes measured: A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR). Results: 751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days’ follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%). Conclusion: Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.Objetivos: Compreender os padrões de uso de produtos biológicos subcutâneos (SC) ao longo do tempo em adultos com doenças musculoesqueléticas reumáticas inflamatórias atendidos em serviço de atendimento domiciliar. Desenho: Coorte retrospectiva. Local: Pacientes na atenção secundária recebendo produtos biológicos SC no maior Scottish Health Board. Participantes: Uma nova coorte personalizada foi criada a partir de dados de rotina coletados como parte de um banco de dados de serviços de assistência domiciliar do conselho de saúde. Foram incluídos pacientes maiores de 18 anos que receberam fornecimento de produtos biológicos SC de janeiro de 2012 a maio de 2015 com diagnóstico de artrite reumatóide (AR), artrite psoriática (APs) ou espondilite anquilosante (EA). Resultados medidos: Uma estrutura padronizada foi aplicada medindo as taxas de descontinuação, persistência usando análise de Kaplan-Meier e regressão de Cox e adesão usando adesão à recarga de medicação (MRA) e taxa de conformidade (CR). Resultados: foram identificados 751 pacientes (EA: 105, AP: 227, AR: 419), dos quais 89,3% tiveram mais de um parto biológico (mediana de dias de acompanhamento: AS: 494; AP: 544; AR: 529) e 83,2% não trocaram de biológico. Para todas as condições, aproximadamente metade foi persistente em seu índice biológico (52% EA, 54% AP, 48% AR). Dos pacientes que descontinuaram o tratamento, a maioria reiniciou com o mesmo medicamento biológico (19% EA, 18% AP e 21% AR). A adesão geral durante o período de tratamento foi superior a 80% quando calculada usando MRA (mediana %MRA: AS: 84,0%, AP: 85,0%, AR: 82,4%) ou CR (mediana %CR: AS: 96,6%, AP: 97 %, AR: 96,6%). Conclusão: O uso de dados de rotina vinculados é um caminho sustentável para permitir a avaliação contínua do uso de produtos biológicos. Uma abordagem mais consistente para estudar o uso (métricas de descontinuação, persistência e adesão) deve ser adotada para permitir a comparabilidade dos estudos.engUniversidade Federal de Minas GeraisUFMGBrasilFAR - DEPARTAMENTO DE FARMÁCIA SOCIALBMJ OpenDoenças reumáticasDoenças musculoesqueléticasProdutos biológicosAdesão à medicaçãoInflammatory rheumatic musculoskeletal diseasesMedication adherenceBiological drugsMedication persistenceDiscontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseasesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleSamantha Alvarez-MadrazoKimberley KavanaghStefan SiebertYvonne SempleBrian GodmanAlessandra Maciel AlmeidaFrancisco de Assis AcurcioMarion Bennieapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/61168/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALDiscontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases a retrospective study.pdfDiscontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases a retrospective study.pdfapplication/pdf993074https://repositorio.ufmg.br/bitstream/1843/61168/2/Discontinuation%2c%20persistence%20and%20adherence%20to%20subcutaneous%20biologics%20delivered%20via%20a%20homecare%20route%20to%20Scottish%20adults%20with%20rheumatic%20diseases%20a%20retrospective%20study.pdfe320d1fc2729b93b037cbbf580ec7e70MD521843/611682023-11-20 21:43:25.866oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-11-21T00:43:25Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
title |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
spellingShingle |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases Samantha Alvarez-Madrazo Inflammatory rheumatic musculoskeletal diseases Medication adherence Biological drugs Medication persistence Doenças reumáticas Doenças musculoesqueléticas Produtos biológicos Adesão à medicação |
title_short |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
title_full |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
title_fullStr |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
title_full_unstemmed |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
title_sort |
Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases |
author |
Samantha Alvarez-Madrazo |
author_facet |
Samantha Alvarez-Madrazo Kimberley Kavanagh Stefan Siebert Yvonne Semple Brian Godman Alessandra Maciel Almeida Francisco de Assis Acurcio Marion Bennie |
author_role |
author |
author2 |
Kimberley Kavanagh Stefan Siebert Yvonne Semple Brian Godman Alessandra Maciel Almeida Francisco de Assis Acurcio Marion Bennie |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Samantha Alvarez-Madrazo Kimberley Kavanagh Stefan Siebert Yvonne Semple Brian Godman Alessandra Maciel Almeida Francisco de Assis Acurcio Marion Bennie |
dc.subject.por.fl_str_mv |
Inflammatory rheumatic musculoskeletal diseases Medication adherence Biological drugs Medication persistence |
topic |
Inflammatory rheumatic musculoskeletal diseases Medication adherence Biological drugs Medication persistence Doenças reumáticas Doenças musculoesqueléticas Produtos biológicos Adesão à medicação |
dc.subject.other.pt_BR.fl_str_mv |
Doenças reumáticas Doenças musculoesqueléticas Produtos biológicos Adesão à medicação |
description |
Objectives: To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design: Retrospective cohort. Setting: Patients in secondary care receiving SC biologics in the largest Scottish Health Board. Participants: A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. Outcomes measured: A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR). Results: 751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days’ follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%). Conclusion: Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-09 |
dc.date.accessioned.fl_str_mv |
2023-11-20T22:11:49Z |
dc.date.available.fl_str_mv |
2023-11-20T22:11:49Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/61168 |
dc.identifier.doi.pt_BR.fl_str_mv |
http://dx.doi.org/10.1136/bmjopen-2018-027059 |
dc.identifier.issn.pt_BR.fl_str_mv |
2044-6055 |
url |
http://dx.doi.org/10.1136/bmjopen-2018-027059 http://hdl.handle.net/1843/61168 |
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2044-6055 |
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eng |
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eng |
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BMJ Open |
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openAccess |
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Universidade Federal de Minas Gerais |
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UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
FAR - DEPARTAMENTO DE FARMÁCIA SOCIAL |
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Universidade Federal de Minas Gerais |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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UFMG |
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