高效和中效改变病情药物在降低美国多发性硬化症患者年复发率方面的疗效比较。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Preventive medicine Pub Date : 2024-11-16 DOI:10.1016/j.ypmed.2024.108180

Jieni Li , George J. Hutton , Tyler J. Varisco , Ying Lin , Ekere J. Essien , Rajender R. Aparasu

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引用次数: 0

摘要

目的：由于高效改变病情药物（heDMAs）的供应量不断增加，治疗多发性硬化症的最佳治疗策略引起了广泛讨论。本研究评估了heDMA和中等疗效疾病修饰药物（meDMA）在降低多发性硬化症患者年复发率（ARR）方面的疗效比较：利用 2015-2019 年美国 Merative MarketScan 商业索赔数据开展了一项回顾性队列研究。研究纳入了使用改变病情药物（DMA）的成人（18-64 岁）患者。采用基于索赔的复发算法来衡量复发事件。采用基于反概率治疗加权（IPTW）的负二项回归模型，并抵消随访期来比较 ARR。研究还考察了性别对 ARR 的调节作用：本研究共纳入 10,003 名 DMA 使用者，其中 22.9% 开始使用 heDMA。在随访期间，heDMA 使用者的平均 ARR 低于 meDMA 使用者（0.25 vs. 0.28，p 结论：研究发现，性别对 ARR 有调节作用：研究发现，性别对heDMAs的影响具有调节作用，使用heDMAs的男性多发性硬化症患者的复发风险比使用meDMAs的患者降低了26%。不过，女性患者的疗效比较没有差异。

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Comparative effectiveness of high-efficacy and moderate efficacy disease-modifying agents in reducing the annualized relapse rates among multiple sclerosis patients in the United States

Objective

The optimal treatment strategy for the management of multiple sclerosis is widely discussed due to the increasing availability of high-efficacy disease-modifying agents (heDMAs). This study evaluated the comparative effectiveness of heDMA and moderate-efficacy disease-modifying agents (meDMAs) use in reducing annualized relapse rate (ARR) among multiple sclerosis patients.

Methods

A retrospective cohort study was conducted using the 2015–2019 United States Merative MarketScan Commercial Claims Data. Adult (18–64 years) patients with incident disease-modifying agents (DMA) use were included. Claim-based relapse algorithms were applied to measure relapse events. The inverse probability treatment weighting (IPTW) based negative binomial regression model with the offset of the follow-up period was used to compare the ARR. The moderation effect of sex on ARR was also examined.

Results

This study included 10,003 incident DMA users, with 22.9 % initiated heDMAs. The average ARR during follow-up among heDMA users was lower than meDMA users (0.25 vs. 0.28, p < 0.01). The IPTW-based regression found that sex moderated the relationship between the types of DMAs and ARR. Stratified analyses revealed that heDMAs were associated with a lower ARR in males (adjusted incidence rate ratio [aIRR] 0.74; 95 % confidence interval [CI] 0.59–0.94) compared with meDMAs. No significant differences were noted among females (aIRR 0.99; 95 % CI: 0.88–1.21).

Conclusion

The study found that sex moderated the effect of heDMAs, with male multiple sclerosis patients using heDMAs associated with a 26 % decreased risk of relapse than those with meDMAs. However, there was no difference in comparative effectiveness for females.

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来源期刊

Preventive medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.70

自引率

3.90%

发文量

审稿时长

42 days

期刊介绍： Founded in 1972 by Ernst Wynder, Preventive Medicine is an international scholarly journal that provides prompt publication of original articles on the science and practice of disease prevention, health promotion, and public health policymaking. Preventive Medicine aims to reward innovation. It will favor insightful observational studies, thoughtful explorations of health data, unsuspected new angles for existing hypotheses, robust randomized controlled trials, and impartial systematic reviews. Preventive Medicine''s ultimate goal is to publish research that will have an impact on the work of practitioners of disease prevention and health promotion, as well as of related disciplines.