Elaine Yung, Xiaoxuan Liu, Minal Aundhia, Chen Chen, Michael Wagner, Bin Huang, Hermine I Brunner
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引用次数: 0
Abstract
Introduction: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune condition that can lead to significant complications if not promptly managed. Current guidelines recommend biologic or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs) as part of the treatment algorithm. In the USA, patients are covered by a wide range of insurance plans that can be broadly classified into two categories-public or private. The influence of insurance type on access to JIA therapies and subsequent outcomes remains poorly understood. The objective of this study was to investigate how b/tsDMARD initiation and achievement of clinically inactive disease (CID) may differ by insurance type in patients with nonsystemic forms of JIA.
Methods: Patients newly diagnosed with JIA according to International League of Associations (ILAR) for Rheumatology classification criteria between 2009 and 2020 at a large tertiary center were studied. Outcome variables of time to b/tsDMARD initiation and time to CID of JIA were assessed. Descriptive statistics were performed, and patients with public or private insurance were compared cross-sectionally and over the study timeframe using survival analysis.
Results: There were 968 patients with newly diagnosed JIA during the study period; 753 (78%) were privately insured and 215 (22%) were publicly insured. During 5898 patient-years of follow-up, 562 (58%) patients initiated b/tsDMARDs and 677 (70%) patients achieved CID. Time to b/tsDMARD initiation did not differ by insurance type (both approximately 5 months, p = 0.51). Publicly insured patients had higher baseline disease activity and longer time to CID achievement compared with the privately insured (10 months versus 7 months, p < 0.001).
Conclusion: While time to b/tsDMARD initiation was similar across insurance groups, publicly insured patients achieved CID later than privately insured patients. These findings may be interpreted as insurance-associated differences. Additional studies are needed to clarify the roles of baseline disease severity, healthcare access, adherence, and socioeconomic context factors.
Supplementary information: The online version contains supplementary material available at 10.1007/s40267-026-01241-0.
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Drugs & Therapy Perspectives promotes rational pharmacotherapy and effective disease management by publishing concise, authoritative review articles to aid drug formulary and treatment decisions, and original research articles covering all aspects of pharmacological treatment to assist healthcare professionals in providing quality patient care. It focuses on the practical application of research and best evidence for healthcare professionals working in real-world clinical settings. TheJournal includes:
Reviews of pharmacological agents, disease management, adverse drug reactions and interactions, or other clinically relevant issues. These provide up-to-date guidance on the use of pharmacological agents in the real-world setting, including step-by-step patient care guidelines to aid treatment decisions, and the differential features of drugs to enable formulary comparisons.Original research articles with a strong focus on clinical practice and real-world outcomes to assist healthcare professionals in providing quality evidence-based patient care.Therapy-in-practice articles, current opinions and commentaries giving international viewpoints on emerging issues and therapeutic approaches to specific diseases or therapeutic questions.
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