用抗cd20治疗的多发性硬化症患者改用富马酸盐治疗的临床特征和治疗结果:对美国医疗索赔数据库的回顾性分析

IF 1.9 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Aliza B Ben-Zacharia, Jenny J Feng, Brandon P Moss, Nicholas Belviso, Yu Zhang, Filipe Branco, Jason P Mendoza, James B Lewin, Sarah M England
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引用次数: 0

摘要

目的:抗cd20单克隆抗体和富马酸盐是常见的多发性硬化症(MS)疾病改善疗法(DMTs)。从抗cd20到其他dmt的转换数据有限。这项对美国Komodo健康哨兵索赔数据库的回顾性观察性研究旨在评估现实世界队列中的降级策略,比较≥18岁的稳定MS患者从抗cd20切换到富富酸盐(“切换者”)与继续使用抗cd20(“停留者”)的患者的临床特征、复发、医疗保健遭遇(HCEs)和医疗保健成本(HCCs)。材料与方法:MS患者(2015年1月1日- 2022年8月31日确诊)倾向评分匹配5:1(停留者:转换者),从研究开始到研究结束进行随访;保险资格终止;>指数DMT 45天缺口;或DMT开关。主要结局是临床特征和基于索赔的年化复发率(ARR)。估计hce和hcc的发生率。结果:基线特征在队列之间得到了很好的平衡(Stayers, n = 540;切换者,n = 108)。两个队列的指数后随访的平均(SD)时间为341.4(250.0)天。平均(SD) ARR为0.08 (0.41;留宿者)vs . 0.14 (0.5;转换器;p = 0.3)。21名住院患者(3.9%)和1名转院患者(0.9%)因感染住院,平均住院时间分别为9.9天和1天。各组间平均年化全因hce相似;住院患者感染相关的年化hce高于转院患者(平均差异:-0.05;p = 0.005)。群组间的年化全因hcc相似;总体而言,转换者的年化感染相关hcc较低(平均差异:- 2412美元;P = 0.002)和住院患者(平均差异:- 2325美元;p = 0.002)。结论:1年后,各组间ARR无显著差异。转换者经历了较低的住院感染相关hce,较短的住院感染相关住院时间和较低的总体感染相关hcc。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical characteristics and treatment outcomes in multiple sclerosis patients treated with anti-CD20s who switched to fumarates: a retrospective analysis of a US healthcare claims database.

Aim: Anti-CD20 monoclonal antibodies and fumarates are common multiple sclerosis (MS) disease-modifying therapies (DMTs). Data on switching from anti-CD20s to other DMTs are limited. This retrospective, observational study of the US Komodo Health Sentinel claims database aimed to evaluate a de-escalation strategy in a real-world cohort, comparing clinical characteristics, relapses, healthcare encounters (HCEs) and healthcare costs (HCCs) between patients aged ≥18 years with stable MS who switched from anti-CD20s to fumarates ('Switchers') versus patients who stayed on anti-CD20s ('Stayers'). Materials & methods: Patients with MS (diagnosed 1 January 2015-31 August 2022) were propensity score matched 5:1 (Stayers:Switchers) and followed from index to end of study; end of insurance eligibility; >45-day gap in index DMT; or DMT switch. Primary outcomes were clinical characteristics and claims-based annualized relapse rate (ARR). Rates of HCEs and HCCs were estimated. Results: Baseline characteristics were well balanced between cohorts (Stayers, n = 540; Switchers, n = 108). Mean (SD) duration of post-index follow-up was 341.4 (250.0) days for both cohorts. Mean (SD) ARR was 0.08 (0.41; Stayers) versus 0.14 (0.5; Switchers; p = 0.3). Twenty-one Stayers (3.9%) and 1 Switcher (0.9%) were hospitalized for infections, with mean stays of 9.9 and 1 day, respectively. Mean annualized all-cause HCEs were similar between cohorts; annualized inpatient infection-related HCEs were higher for Stayers versus Switchers (mean difference: -0.05; p = 0.005). Annualized all-cause HCCs were similar between cohorts; Switchers had lower annualized infection-related HCCs overall (mean difference: -$2412; p = 0.002) and in the inpatient setting (mean difference: -$2325; p = 0.002). Conclusion: After 1 year, no significant differences in ARR emerged between cohorts. Switchers experienced lower inpatient infection-related HCEs, shorter inpatient infection-related hospital stays and lower overall infection-related HCCs.

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来源期刊
Journal of comparative effectiveness research
Journal of comparative effectiveness research HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.50
自引率
9.50%
发文量
121
期刊介绍: Journal of Comparative Effectiveness Research provides a rapid-publication platform for debate, and for the presentation of new findings and research methodologies. Through rigorous evaluation and comprehensive coverage, the Journal of Comparative Effectiveness Research provides stakeholders (including patients, clinicians, healthcare purchasers, and health policy makers) with the key data and opinions to make informed and specific decisions on clinical practice.
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