Use of Analgesic and Anti-Inflammatory Medicines before and after Initiation of Biological Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis

IF 2.1 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Svetla Gadzhanova, Elizabeth Roughead
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Abstract

Background. Rheumatoid arthritis (RA) is an inflammatory condition that causes joint damage and is associated with pain. The biological disease-modifying antirheumatic drugs (bDMARDs) for RA are linked to additional therapeutic benefits as they suppress the inflammatory process, which in turn prevents joint erosion and reduces pain. Thus, the use of bDMARDs has the potential to reduce the need for other analgesic and anti-inflammatory therapies for RA. The aim of this study was to examine the analgesic and anti-inflammatory use around the initiation of bDMARDs. Methods. A cohort study was conducted using a 10% random sample of the population dispensing medicines under the Australian Pharmaceutical Benefits Scheme. People who initiated the first bDMARD for RA between 2014 and 2018 were included. The proportion who received any analgesic or anti-inflammatory, including nonsteroidal anti-inflammatory drugs, opioids, or glucocorticoids, in the twelve months prior to and post-bDMARD initiation was determined and compared using regression models. Results. There were 18,360 persons in the cohort, with a mean age of 55 years, and 69% were women. The use of any analgesic or anti-inflammatory in both tumor necrosis factor inhibitor (TNFi) and non-TNF initiators increased prior to initiation of bDMARD–from 43% to 52% in TNFi and from 52% to 63% in non-TNF initiators. In both groups, overall use decreased significantly post initiation to 37% and 42% in TNFi and non-TNF initiators, respectively (p < 0.0001). bDMARD initiation was associated with lower use of glucocorticoid therapy, but there was no decreasing effect on opioid use. Conclusion. While the use of any analgesic or anti-inflammatories decreased post-initiation of bDMARDs for RA, more than one-third of people were dispensed analgesic or anti-inflammatory agents twelve months post initiation. Ongoing review of the need for analgesic and glucocorticoids appears warranted, with assessment of nonpharmacological approaches to support pain management.

类风湿性关节炎患者在开始使用改变病情抗风湿生物制剂前后镇痛药和消炎药的使用情况
背景。类风湿性关节炎(RA)是一种炎症性疾病,会导致关节损伤并伴有疼痛。治疗类风湿性关节炎的生物改良抗风湿药(bDMARDs)具有额外的治疗效果,因为它们能抑制炎症过程,从而防止关节侵蚀并减轻疼痛。因此,使用生物多巴胺抗炎药有可能减少对其他止痛和抗炎疗法的需求。本研究的目的是检查在开始使用 bDMARDs 时镇痛和抗炎药物的使用情况。研究方法。在澳大利亚药品福利计划(Australian Pharmaceutical Benefits Scheme)的配药人群中随机抽取10%的样本进行队列研究。研究纳入了2014年至2018年期间首次使用bDMARD治疗RA的患者。使用回归模型确定了在开始使用bDMARD之前和之后的12个月内接受任何镇痛或抗炎药物(包括非甾体抗炎药物、阿片类药物或糖皮质激素)的比例,并进行了比较。结果队列中有 18,360 人,平均年龄为 55 岁,69% 为女性。在开始使用bDMARD之前,肿瘤坏死因子抑制剂(TNFi)和非TNF起始者使用任何镇痛药或抗炎药的比例都有所上升--TNFi起始者从43%上升到52%,非TNF起始者从52%上升到63%。在两组患者中,TNFi和非TNF起始者的总体使用率在起始后均显著下降,分别为37%和42%(P<0.0001)。bDMARD的起始与糖皮质激素治疗的使用率降低有关,但对阿片类药物的使用率没有降低作用。结论。虽然在开始使用bDMARDs治疗RA后,镇痛药或消炎药的使用有所减少,但超过三分之一的患者在开始使用bDMARDs治疗12个月后仍在使用镇痛药或消炎药。看来有必要对镇痛药和糖皮质激素的需求进行持续审查,并对支持疼痛管理的非药物方法进行评估。
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来源期刊
CiteScore
4.10
自引率
5.00%
发文量
226
审稿时长
6 months
期刊介绍: The Journal of Clinical Pharmacy and Therapeutics provides a forum for clinicians, pharmacists and pharmacologists to explore and report on issues of common interest. Reports and commentaries on current issues in medical and pharmaceutical practice are encouraged. Papers on evidence-based clinical practice and multidisciplinary collaborative work are particularly welcome. Regular sections in the journal include: editorials, commentaries, reviews (including systematic overviews and meta-analyses), original research and reports, and book reviews. Its scope embraces all aspects of clinical drug development and therapeutics, including: Rational therapeutics Evidence-based practice Safety, cost-effectiveness and clinical efficacy of drugs Drug interactions Clinical impact of drug formulations Pharmacogenetics Personalised, stratified and translational medicine Clinical pharmacokinetics.
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