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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Carter K, Lippe R, Photowala H, Drogaris L, Soliman AM, Chen M, Padilla B, Behrens F. Efficacy and Safety of Risankizumab for Active Psoriatic Arthritis: 100-Week Results from the Phase 3 KEEPsAKE 1 Randomized Clinical Trial. Rheumatol Ther 2024:10.1007/s40744-024-00654-5. [PMID: 38498141 DOI: 10.1007/s40744-024-00654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Patients with psoriatic arthritis (PsA) require treatment providing durable long-term efficacy in different disease domains as well as safety. We present 100-week efficacy and safety results of risankizumab in patients with active PsA and previous inadequate response/intolerance to ≥ 1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR). METHODS KEEPsAKE 1 (NCT03675308) is a global phase 3 study, including a 24-week, double-blind, placebo-controlled and ongoing open-label extension periods. Patients were randomized 1:1 to receive risankizumab 150 mg or placebo at baseline and weeks 4 and 16. After week 24, all patients received open-label risankizumab every 12 weeks thereafter. Patients were evaluated through 100 weeks. Endpoints included achieving ≥ 20% reduction in American College of Rheumatology criteria for symptoms of rheumatoid arthritis (ACR20), minimal disease activity (MDA; defined as ≥ 5/7 criteria of low disease activity and extent), and other measures. RESULTS Overall, 828/964 (85.9%) patients completed week 100. For patients receiving continuous risankizumab, 57.3%, 70.6%, and 64.3% achieved ACR20 at weeks 24, 52, and 100, respectively. For the placebo/risankizumab cohort, 33.5% achieved ACR20 at week 24 but increased after switching to active treatment at weeks 52 (63.7%) and 100 (62.1%). In ACR20 responders at week 52, 81.2% of both treatment cohorts maintained response at week 100. MDA was achieved by 25.0%, 38.3%, and 38.2% of the continuous risankizumab cohort at weeks 24, 52, and 100. In the placebo/risankizumab cohort, 10.2% achieved MDA at week 24, increasing at weeks 52 (28.0%) and 100 (35.2%). MDA response was maintained at week 100 in week 52 responders in the continuous risankizumab (75.5%) and placebo/risankizumab cohorts (78.2%). Similar trends were observed for other efficacy measures. Risankizumab was generally well tolerated through 100 weeks. CONCLUSIONS For patients with active PsA who are csDMARD-IR, risankizumab demonstrated durable long-term efficacy and was generally well tolerated, with a consistent long-term safety profile. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57 Road 8, Entrance 19, 2000, Frederiksberg, Copenhagen, Denmark.
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | | | | | | | | | - Frank Behrens
- Rheumatology, Immunology, Inflammation Medicine, University Hospital and Fraunhofer Institute for Translational Medicine & Pharmacology ITMP, Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Goethe University, Frankfurt Am Main, Germany
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Östör A, Van den Bosch F, Papp K, Asnal C, Blanco R, Aelion J, Carter K, Stakias V, Lippe R, Drogaris L, Soliman AM, Chen MM, Padilla B, Kivitz A. Efficacy and Safety of Risankizumab for Active Psoriatic Arthritis: 100-Week Results from the KEEPsAKE 2 Randomized Clinical Trial. Rheumatol Ther 2024:10.1007/s40744-024-00657-2. [PMID: 38498139 DOI: 10.1007/s40744-024-00657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Long-term therapeutic options providing durable response and tolerability are needed for psoriatic arthritis (PsA). The ongoing KEEPsAKE 2 trial is evaluating risankizumab treatment in patients with active PsA who previously had inadequate response/intolerance to ≥ 1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR) and/or 1-2 biologic DMARDs (bDMARD-IR). Herein, we report results through 100 weeks of treatment. METHODS KEEPsAKE 2 is a global phase 3 trial. Patients with active PsA were randomized 1:1 to double-blind subcutaneous risankizumab 150 mg or placebo (weeks 0, 4, and 16). At week 24, all patients received open-label risankizumab every 12 weeks until end of study. Efficacy endpoints included achieving ≥ 20% improvement in PsA symptoms using American College of Rheumatology criteria (ACR20), attaining minimal disease activity (MDA; meeting ≥ 5/7 criteria of low disease activity and extent), and improving in other measures. RESULTS At the cutoff date, 345/443 (77.9%) patients were ongoing in the study. ACR20 was achieved in 57.1% and 52.5% of the continuous risankizumab and placebo/risankizumab cohorts, respectively, at week 100 and in 60.0% and 55.8%, respectively, at week 52. In week 52 responders, maintenance of ACR20 at week 100 was achieved in 74.8% (continuous risankizumab) and 78.7% (placebo/risankizumab) of patients. In the continuous risankizumab and placebo/risankizumab cohorts, respectively, MDA was achieved by 33.0% and 33.3% of patients at week 100 and by 27.2% and 33.8% at week 52. Among MDA responders at week 52, maintenance of MDA response was achieved by 83.6% and 73.0% of the continuous risankizumab and placebo/risankizumab cohorts, respectively. Risankizumab was well tolerated through week 100. CONCLUSIONS Risankizumab demonstrated durable efficacy and tolerability through 100 weeks; most patients who achieved ACR20 and MDA responses at week 52 maintained this achievement through week 100. There were no new safety signals in patients who had csDMARD-IR and bDMARD-IR. TRIAL REGISTRATION ClinicalTrials.gov NCT03671148.
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Affiliation(s)
- Andrew Östör
- Department of Medicine, Monash University, Clayton, VIC, Australia.
- Department of Medicine, Australian National University, Canberra, ACT, Australia.
- Emeritus Research, Level 2/1180 Toorak Rd, Camberwell, VIC, 3124, Australia.
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Kim Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL (Immunopathology Group), Santander, Spain
| | - Jacob Aelion
- Arthritis Clinic and West Tennessee Research Institute, Jackson, TN, USA
| | | | | | | | | | | | | | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
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Xu X, Wu LY, Wang SY, Yan M, Wang YH, Li L, Sun ZL, Zhao JX. Investigating causal associations among gut microbiota, metabolites, and psoriatic arthritis: a Mendelian randomization study. Front Microbiol 2024; 15:1287637. [PMID: 38426052 PMCID: PMC10902440 DOI: 10.3389/fmicb.2024.1287637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Background Currently, there has been observed a significant alteration in the composition of the gut microbiome (GM) and serum metabolites in patients with psoriatic arthritis (PsA) compared to healthy individuals. However, previous observational studies have shown inconsistent results regarding the alteration of gut microbiota/metabolites. In order to shed light on this matter, we utilized Mendelian randomization to determine the causal effect of GM/metabolites on PsA. Methods We retrieved summary-level data of GM taxa/metabolites and PsA from publicly available GWAS statistics. Causal relationships between GM/metabolites and PsA were determined using a two-sample MR analysis, with the IVW approach serving as the primary analysis method. To ensure the robustness of our findings, we conducted sensitivity analyses, multivariable MR analysis (MVMR), and additional analysis including replication verification analysis, LDSC regression, and Steiger test analysis. Furthermore, we investigated reverse causality through a reverse MR analysis. Finally, we conducted an analysis of expression quantitative trait loci (eQTLs) involved in the metabolic pathway to explore potential molecular mechanisms of metabolism. Results Our findings reveal that eight GM taxa and twenty-three serum metabolites are causally related to PsA (P < 0.05). Notably, a higher relative abundance of Family Rikenellaceae (ORIVW: 0.622, 95% CI: 0.438-0.883, FDR = 0.045) and elevated serum levels of X-11538 (ORIVW: 0.442, 95% CI: 0.250-0.781, FDR = 0.046) maintain significant causal associations with a reduced risk of PsA, even after adjusting for multiple testing correction and conducting MVMR analysis. These findings suggest that Family Rikenellaceae and X-11538 may have protective effects against PsA. Our sensitivity analysis and additional analysis revealed no significant horizontal pleiotropy, reverse causality, or heterogeneity. The functional enrichment analysis revealed that the eQTLs examined were primarily associated with glycerolipid metabolism and the expression of key metabolic factors influenced by bacterial infections (Vibrio cholerae and Helicobacter pylori) as well as the mTOR signaling pathway. Conclusion In conclusion, our study demonstrates that Family Rikenellaceae and X-11538 exhibit a strong and negative causal relationship with PsA. These particular GM taxa and metabolites have the potential to serve as innovative biomarkers, offering valuable insights into the treatment and prevention of PsA. Moreover, bacterial infections and mTOR-mediated activation of metabolic factors may play an important role in this process.
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Affiliation(s)
- Xiao Xu
- Department of Nursing, Nantong Health College of Jiangsu Province, Nantong, China
| | - Lin-yun Wu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shu-yun Wang
- Academic Affair Office, Nantong Vocational University, Nantong, China
| | - Min Yan
- Department of Epidemiology, School of Public Health, Changzhou University, Changzhou, China
- Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Yuan-Hong Wang
- Department of Rheumatology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Li
- Department of Rheumatology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhi-ling Sun
- Department of Epidemiology, School of Public Health, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ji-Xiang Zhao
- Department of Nursing, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
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Bautista-Molano W, Ibatá L, Martínez S, Chacón A. Burden of Disease in Psoriatic Arthritis in Latin America: a Systematic Literature Review. Clin Rheumatol 2024; 43:677-693. [PMID: 38114817 DOI: 10.1007/s10067-023-06838-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Psoriatic arthritis is a chronic inflammatory pathology that generates a substantial and progressive deterioration of functionality and quality of life. It is associated with comorbidities (cardiovascular and metabolic) and involvement of mental health. In Latin America, information regarding the disease is limited. This study reviews the burden of disease (disease activity, functional involvement, clinical manifestations, comorbidities, patient-reported outcomes, quality of life, and use of health resources) in PsA patients in Latin America. METHODS Systematic literature review of publications in PUBMED, EMBASE, Cochrane Database of Systematic Reviews-CDSR/Database of Abstracts of Reviews of Effects, LILACS, Scielo, Redalyc, conference abstracts, and grey literature. Two independent assessors selected studies and extracted information. Quality was assessed according to the type of study. RESULTS We identified 692 references, selecting 50 studies: 41 cross-sectional, four economic-studies, four cohort studies and one systematic review. The information comes mainly from Brazil, Argentina, and Mexico. The estimated disease prevalence for Latin America ranges from 0.004 to 0.08% (95% CI 0.02-0.20). Measurements with validated instruments suggest suboptimal assessment of disease domains, significant functional compromise, loss of productivity, and high frequency of comorbidities, including mental health. Methodological and population considerations limit the generalizability of the findings. CONCLUSIONS The available information reports a considerable burden of disease in patients with PsA in Latin America, with involvement of quality of life associated with disability in relation to disease activity and its various manifestations. Future research and funding efforts should be aimed at generating more standardized information about the impact of PsA in the region. Key Points •The functional involvement related to disease activity, the impact on the quality of life, and the frequency of cardiometabolic and psychological comorbidities are remarkable in Latin American patients with PsA. •The current synthesis offers an overview of the burden of disease (disease activity, functional involvement, clinical manifestations, comorbidities, patient-reported outcomes, quality of life, and use of health resources) in PsA patients in Latin America. •Future research efforts and clinical strategies are required in order to generate standardized data on the patients and better estimate the burden of disease in the region.
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Affiliation(s)
- Wilson Bautista-Molano
- Rheumatologist University Hospital Fundación Santa Fe de Bogotá, School of Medicine Universidad El Bosque, School of Medicine Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Linda Ibatá
- Epidemióloga, MPH, InValue Health Solutions, Bogotá, Colombia
| | - Susan Martínez
- Epidemióloga, MPH, InValue Health Solutions, Bogotá, Colombia
| | - Andrea Chacón
- Chemistry Pharmaceutical Epidemiologist, InValue Health Solutions, Bogotá, Colombia
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Bosch P, Zhao SS, Nikiphorou E. The association between comorbidities and disease activity in spondyloarthritis - A narrative review. Best Pract Res Clin Rheumatol 2023; 37:101857. [PMID: 37541813 DOI: 10.1016/j.berh.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
Comorbidities, including cardiovascular disease, osteoporosis, and depression, are more prevalent in patients with spondyloarthritis (SpA) than in the general population. Clinical and laboratory markers of disease activity are associated with numerous of these comorbidities, and studies suggest that the treatment of SpA can have a positive impact on comorbidities; conversely, managing comorbidities can improve disease activity. Therefore, the screening of comorbidities is considered a core component of a rheumatology consultation, and treatment should be performed in liaison with other health professionals (e.g. general physicians). Validated tools and questionnaires can be used for not only the detection but also the monitoring of potential comorbidities. Understanding whether a comorbidity is a separate disease entity, linked to SpA or its treatment, or an extra-musculoskeletal manifestation of the disease is important to identify the most appropriate treatment options.
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Affiliation(s)
- Philipp Bosch
- Clinical Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elena Nikiphorou
- Center for Rheumatic Diseases, King's College London, London, United Kingdom; Rheumatology Department, King's College Hospital, London, United Kingdom
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Huang X, Shentu H, He Y, Lai H, Xu C, Chen M, Zhu H. Efficacy and safety of IL-23 inhibitors in the treatment of psoriatic arthritis: a meta-analysis based on randomized controlled trials. Immunol Res 2023; 71:505-515. [PMID: 36811818 PMCID: PMC10425519 DOI: 10.1007/s12026-023-09366-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
In recent years, the use of interleukin (IL) 23 inhibitors in the treatment of psoriatic arthritis (PsA) has been the subject of much research. By specifically binding to the p19 subunit of IL-23, IL-23 inhibitors block downstream signaling pathways and inhibit inflammatory responses. The objective of this study was to assess the clinical efficacy and safety of IL-23 inhibitors in the treatment of PsA. PubMed, Web of Science, Cochrane Library, and EMBASE databases were searched from the time of conception to June 2022 for randomized controlled trials (RCTs) investigating the use of IL-23 in PsA therapy. The main outcome of interest was the American College of Rheumatology 20 (ACR20) response rate at week 24. We included six RCTs (3 studies on guselkumab, 2 on risankizumab, and 1 on tildrakizumab) with a total of 2971 PsA patients in our meta-analysis. We found that the IL-23 inhibitor group showed a significantly higher ACR20 response rate compared to the placebo group (relative risk = 1.74, 95% confidence interval: 1.57-1.92; P < 0.001; I2 = 40%). There was no statistical difference in the risk of adverse events (P = 0.07) and serious adverse events (P = 0.20) between the IL-23 inhibitor and placebo groups. Notably, the rate of elevated transaminases in the IL-23 inhibitor group was higher than the placebo group (relative risk = 1.69; 95%CI 1.29-2.23; P < 0.001; I2 = 24%). In the treatment of PsA, IL-23 inhibitors significantly outperform placebo intervention while maintaining a favorable safety profile.
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Affiliation(s)
- Xiaojing Huang
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, 998 North Qianhe Road, Yinzhou District, Ningbo, Zhejiang, 315100 China
| | - Haojie Shentu
- School of Medical Imaging, Hangzhou Medical College, Zhejiang, Hangzhou China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou China
| | - Haijia Lai
- School of Medical Imaging, Hangzhou Medical College, Zhejiang, Hangzhou China
| | - Chen Xu
- School of Nursing, Hangzhou Medical College, Zhejiang, Hangzhou China
| | - Meiling Chen
- The Public Health College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou China
| | - Haowei Zhu
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, 998 North Qianhe Road, Yinzhou District, Ningbo, Zhejiang, 315100 China
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Lu W, Soliman AM, Eldred A, Barcomb L, Behrens F. Efficacy and safety of risankizumab for active psoriatic arthritis: 52-week results from the KEEPsAKE 1 study. Rheumatology (Oxford) 2023; 62:2113-2121. [PMID: 36282530 PMCID: PMC10234205 DOI: 10.1093/rheumatology/keac607] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/15/2022] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE PsA is a chronic disease with heterogeneous clinical manifestations requiring treatment options with long-term efficacy and safety. In this follow-up analysis, the 52-week efficacy and safety of risankizumab 150 mg in patients with active PsA who had previous inadequate response/intolerance to one or more conventional synthetic DMARDs (csDMARD-IR) were evaluated. METHODS KEEPsAKE 1 is an ongoing, global, phase 3 study with a 24-week, double-blind, placebo-controlled period (period 1) and an open-label extension period (period 2). In period 1, eligible patients were randomized 1:1 to receive subcutaneous risankizumab 150 mg or placebo at weeks 0, 4 and 16. At week 24 (period 2), all continuing patients received open-label risankizumab 150 mg every 12 weeks through week 208. RESULTS At week 24, 57.3% of risankizumab-treated patients (n = 483) achieved ≥20% improvement in ACR criteria (ACR20) vs 33.5% of placebo-treated patients (n = 481; P < 0.001). At week 52, 70.0% of patients who were randomized to receive continuous risankizumab therapy and 63.0% of patients who were randomized to receive placebo in period 1 and then receive risankizumab at week 24 achieved ACR20. Similar result trends were observed for other efficacy measures. Risankizumab was well tolerated through 52 weeks of treatment with a consistent safety profile from week 24 through week 52. CONCLUSION In patients with active PsA who were csDMARD-IR, continuous risankizumab treatment demonstrated robust long-term efficacy and was well tolerated through 52 weeks of treatment. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, KEEPsAKE1, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research–K Papp Clinical Research, Waterloo, ON, Canada
| | - Leslie McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, IL, USA
- Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | | | - Frank Behrens
- Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Fraunhofer Cluster of Excellence for Immune-Mediated Disease (CIMD), Goethe University, Frankfurt, Germany
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Fairushina IF, Abdulganieva DI, McKenna SP, Сoffey A. Psoriatic Arthritis Quality of Life Questionnaire: results of translation, cultural adaptation and validation in Russian language. Sovremennaâ revmatologiâ 2023. [DOI: 10.14412/1996-7012-2023-1-58-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic progressive disease from the pondyloarthritis group of diseases. In recent years, there has been a significant increase in the incidence of PsA and cases of its severe course, with significant influence on the quality of life (QoL) of patients and early disability. Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) is the first quality of life questionnaire designed specifically for PsA that has not been previously validated in Russia.Objective: to translate the original PsAQoL questionnaire into Russian and evaluate the psychometric properties of the Russian version.Material and methods. The original PsAQoL was translated into Russian using two translational panels. In all, 12 local residents were included in the translation stage of the study. The external and logical validity of the questionnaire was assessed. Further, Russian-speaking patients with an established diagnosis of PsA (n=10) tested the questionnaire. A separate cohort of patients with PsA (n=50) was enrolled in a postal test retest study on 2 occasions, 2 weeks apart. Clinical data and the Medical Outcomes Study-Short Form (SF-36) questionnaire were used to assess convergent validity.Results and discussion. The Russian version of PsAQoL was relevant, clear, and easy to complete (6.1 minutes on average). PsAQoL had high internal consistency (Cronbach's á=0.87) and excellent retest validity (r>0.85). PsAQoL scores correlated most strongly with the SF-36 General Health Scale (r=-0.68, p<0.01). PsAQoL score did not depend on sex and age (p>0.05). The PsAQoL could distinguish between groups of patients defined by self-reported general health status and self-reported severity of PsA.Conclusion. The Russian version of PsAQoL proved to be understandable and easy to complete, as well as a reliable and valid tool for assessing the quality of life of patients with PsA.
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Affiliation(s)
| | | | - S. P. McKenna
- Galen Research Ltd, Manchester;
School of Health Sciences, University of Manchester
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Kristensen LE, Strober B, Poddubnyy D, Leung YY, Jo H, Kwok K, Vranic I, Fleishaker DL, Fallon L, Yndestad A, Gladman DD. Association between baseline cardiovascular risk and incidence rates of major adverse cardiovascular events and malignancies in patients with psoriatic arthritis and psoriasis receiving tofacitinib. Ther Adv Musculoskelet Dis 2023; 15:1759720X221149965. [PMID: 36777695 PMCID: PMC9909057 DOI: 10.1177/1759720x221149965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
Background Tofacitinib is a Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA) and has been investigated for psoriasis (PsO). Objectives This post hoc analysis examined baseline cardiovascular (CV) disease risk and its association with the occurrence of major adverse cardiovascular events (MACE) and malignancies in tofacitinib-treated patients with PsA and PsO. Design Included three phase III/long-term extension (LTE) PsA trials and seven phase II/phase III/LTE PsO trials of patients receiving ⩾ 1 dose of tofacitinib. Methods Incidence rates (IRs: patients with events/100 patient-years) for MACE and malignancies (excluding non-melanoma skin cancer) were determined in subgroups according to history of atherosclerotic CV disease (ASCVD), baseline 10-year risk of ASCVD (in patients without history of ASCVD), and baseline metabolic syndrome (MetS). Results For patients with PsA (N = 783) and PsO (N = 3663), respectively, tofacitinib exposure was 2038 and 8950 patient-years (median duration: 3.0 and 2.4 years), and 40.9% and 32.7% had MetS. Excluding missing CV risk profile data, 51/773 (6.6%) and 144/3629 (4.0%) patients had history of ASCVD, and in patients without history of ASCVD, around 20.0% had intermediate/high baseline 10-year ASCVD risk. For PsA and PsO, IRs of MACE were greatest in those with history of ASCVD or high baseline 10-year ASCVD risk. For PsA, five of six patients with MACE had baseline MetS. Malignancy IRs in patients with PsA were greatest in those with intermediate/high baseline 10-year ASCVD risk. Of these, eight of nine patients with malignancies had baseline MetS. In the PsO cohort, IR of malignancies was notably greater with high versus low/borderline/intermediate baseline 10-year ASCVD risk. Conclusion In tofacitinib-treated patients with PsA/PsO, increased ASCVD risk and baseline MetS were associated with higher IRs for MACE and malignancies. Our results support assessing CV risk in patients with PsA/PsO and suggest enhanced cancer monitoring in those with increased ASCVD risk. Registration ClinicalTrialsgov NCT01877668/NCT01882439/NCT01976364/NCT00678210/NCT01710046/NCT01241591/NCT01186744/NCT01276639/NCT01309737/NCT01163253. Plain Language Summary People who have psoriatic arthritis or psoriasis may have more heart-related problems and cancer if they have a higher risk of cardiovascular disease: A study in people with psoriatic arthritis or psoriasis receiving tofacitinib Why was this study done? • People with psoriatic arthritis (PsA) and psoriasis (PsO) are more likely than the general population to have a disease affecting the heart and blood vessels [cardiovascular (CV) disease].• People who are more likely to have CV disease may also be more likely to have certain types of cancer.• Tofacitinib is a medicine to treat people with PsA and has been tested in people with PsO.• We wanted to know if the risk of CV disease affects the number of heart-related problems (including heart attack, stroke, or death) and cancer in people with PsA and PsO. What did the researchers do? • We used results from 10 clinical trials.• In these trials, people with PsA and PsO were taking tofacitinib 5 or 10 mg twice a day.• After the trials had ended, we measured people's risk of CV disease using a risk calculator. This risk calculator showed if they had a low, borderline, intermediate, or high risk of CV disease over the next 10 years. We also checked if they had had CV disease before treatment.• We checked if people had a group of conditions linked to CV disease: diabetes, high blood pressure, and obesity.• We counted the cases of heart-related problems and cancer in people once they started taking tofacitinib. What did the researchers find? In people with PsA and PsO taking tofacitinib:• There were more cases of heart-related problems and cancer in people who had intermediate or high risk of CV disease.• There were more cases of heart-related problems in people who had had CV disease before.• More people with diabetes, high blood pressure, and obesity had heart-related problems and cancer than people without those conditions. What do the findings mean? • It is important to measure risk and assess history of CV disease in people with PsA and PsO, including those taking tofacitinib.• We should test for cancer in people with high risk of CV disease.
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Affiliation(s)
- Lars E. Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg, Copenhagen, and Copenhagen University, Copenhagen, Denmark
| | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, CT, USA,Yale University, New Haven, CT, USA
| | - Denis Poddubnyy
- Department of Rheumatology, Infectious Diseases and Rheumatology, Charité–Universitätsmedizin Berlin, Berlin, Germany,Epidemiology, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore,Duke-NUS Medical School, Singapore
| | | | | | | | | | | | | | - Dafna D. Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
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10
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Kristensen LE, Soliman AM, Papp K, White D, Barcomb L, Lu W, Eldred A, Behrens F. Risankizumab improved health-related quality of life, fatigue, pain and work productivity in psoriatic arthritis: results of KEEPsAKE 1. Rheumatology (Oxford) 2023; 62:629-637. [PMID: 35801915 PMCID: PMC9891435 DOI: 10.1093/rheumatology/keac342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES PsA is a heterogeneous disease that impacts many aspects of social and mental life, including quality of life. Risankizumab, an antagonist specific for IL-23, is currently under investigation for the treatment of adults with active PsA. This study evaluated the impact of risankizumab vs placebo on health-related quality of life (HRQoL) and other patient-reported outcomes (PROs) among patients with active PsA and inadequate response or intolerance to conventional synthetic DMARD (csDMARD-IR) in the KEEPsAKE 1 trial. METHODS Adult patients with active PsA (n = 964) were randomized (1:1) to receive risankizumab 150 mg or placebo. PROs assessed included the 36-Item Short-Form Health Survey (SF-36, v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), EuroQoL-5 Dimension-5 Level (EQ-5D-5L), Patient's Assessment of Pain, Patient's Global Assessment (PtGA) of Disease Activity, and Work Productivity and Activity Impairment-PsA (WPAI-PsA) questionnaire. Least squares (LS) mean change from baseline at week 24 was compared between risankizumab and placebo. RESULTS At week 24, differences between groups were observed using LS mean changes from baseline in SF-36 physical component summary and mental component summary; FACIT-Fatigue; EQ-5D-5L; Patient's Assessment of Pain; PtGA; all eight SF-36 domains (all nominal P < 0.001); and the WPAI-PsA domains of impairment while working (presenteeism), overall work impairment and activity impairment (all nominal P < 0.01). CONCLUSION Risankizumab treatment resulted in greater improvements in HRQoL, fatigue, pain and work productivity in patients with active PsA who have csDMARD-IR, when compared with placebo. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Kim Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, Ontario, Canada
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton.,Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | - Frank Behrens
- Rheumatology, Fraunhofer Institute Translational Medicine and Pharmacology ITMP & Cluster of Excellence CIMD, Goethe University, Frankfurt, Germany
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11
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de Thurah A, Jensen H, Maribo T, Jensen MB, Sandbæk A, Hauge EM, Rasmussen LA. Use of primary health care and radiological imaging preceding a diagnosis of rheumatoid arthritis: a nationwide cohort study in Denmark. Rheumatology (Oxford) 2023; 62:555-564. [PMID: 35713514 DOI: 10.1093/rheumatology/keac306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To explore health-care use in the 12 months preceding a diagnosis of RA in Denmark. METHODS We conducted a population-based cohort study using data from national registries. Every patient diagnosed with RA in 2014-18 was matched to 10 reference individuals without RA from the Danish background population. Health-care use was defined as contacts to general practitioners, contacts to private practicing physiotherapists, and X-rays of hands and/or feet performed in primary or secondary care. We estimated the monthly contact rates for patients and references in the 12 months preceding the diagnosis, and we compared incidence rates for health-care use in each month between the two groups while adjusting for sociodemographic characteristics and comorbidity. RESULTS We included 7427 patients with RA and 74 270 references. Patients with RA had increasing contact rates with general practitioners and physiotherapists from 6 to 8 months before the diagnosis. Compared with references, women with RA had statistically significantly more contacts to general practitioners and physiotherapists during all 12 months. A similar contact pattern was seen in men, albeit less distinct. The number of X-rays increased slightly from 8 months before the diagnosis, with a steep increase in the last 3 months. CONCLUSION Increased contacts to general practitioners and physiotherapists were seen in all 12 months preceding the RA diagnosis, intensifying in the last 6 to 8 months. Imaging increased from 3 months before the diagnosis. This indicates an opportunity to expedite referral to specialist care and ensure earlier diagnosis of RA.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University
| | | | - Thomas Maribo
- Department of Public Health, Aarhus University.,DEFACTUM, Central Denmark Region, Aarhus
| | | | - Annelli Sandbæk
- Department of Public Health, Aarhus University.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University
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12
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Ogdie A, Hwang M, Veeranki P, Portelli A, Sison S, Shafrin J, Pedro S, Hass S, Hur P, Kim N, Yi E, Michaud K. Health care utilization and costs associated with functional status in patients with psoriatic arthritis. J Manag Care Spec Pharm 2022; 28:997-1007. [PMID: 36001101 PMCID: PMC10372953 DOI: 10.18553/jmcp.2022.28.9.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: The Health Assessment Questionnaire Disability Index (HAQ-DI) has been validated and widely used in psoriatic arthritis (PsA) clinical trials for the assessment of patient functional status. Significant improvements in the HAQ-DI have been reported in response to therapeutic interventions; however, few US studies have evaluated the economic impact of functional disability in patients with PsA. OBJECTIVE: To evaluate the association of functional status with health care resource utilization (HCRU) and total health care costs in US patients diagnosed with PsA. METHODS: This retrospective study included adult patients with PsA enrolled in FORWARD between July 2009 and June 2019 who completed 1 or more HAQ-DI questionnaires between January 2010 and December 2019. Patient demographics, clinical characteristics, and patient-reported outcomes were collected from the most recent questionnaire. HCRU and total health care costs (2019 US dollars) for all hospitalizations, emergency department (ED) visits, outpatient visits, diagnostic tests, and procedures were assessed for the 6 months prior to survey completion. Negative binomial regression models (HCRU outcomes) and generalized linear models with γ distribution and log-link function (cost outcomes) were used to assess the relationship between HAQ-DI and HCRU and cost outcomes, respectively. RESULTS: A total of 828 patients with PsA who completed HAQ-DI questionnaires were included. The mean (SD) age was 58.5 (13.5) years, 72.3% were female, and 92.3% were White. The mean (SD) disease duration was 17.5 (12.4) years, and the mean (SD) HAQ-DI score at the time of the patients' most recent questionnaire was 0.9 (0.7). More severe functional disability, measured by higher HAQ-DI score, was significantly associated with increased risk (incident rate ratio [95% CI]) of hospitalizations (1.68 [1.11-2.55]), ED visits (2.09 [1.47-2.96]), outpatient visits (1.14 [1.05-1.24]), and diagnostic tests (1.42 [1.16-1.74]). There was also a significant positive association between greater HAQ-DI score and increased total annualized health care costs (incremental amount [95% CI], 1.13 [1.03-1.23]) and medical costs (1.38 [1.13-1.69]), but there was no significant association found with pharmacy costs. Total adjusted average patient medical costs increased with increasing HAQ-DI score. CONCLUSIONS: Among patients with PsA enrolled in FORWARD, more functional disability-as measured by higher HAQ-DI scores-was associated with greater HCRU and increased total health care costs. These results suggest that improving functional status in patients with PsA may reduce economic burden for health care payers and systems. DISCLOSURES: Dr Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas (formerly Corrona), Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, National Psoriasis Foundation, Pfizer (University of Pennsylvania), Amgen (FORWARD), and Novartis (FORWARD). Dr Hwang has received consulting fees from Novartis and UCB and has received grant support (5KL2TR003168-03) from the University of Texas Health Science Center at Houston Center of Clinical and Translational Sciences KL2 program. Drs Veeranki and Shafrin were employees of PRECISIONheor at the time of this analysis. Ms Portelli and Mr Sison are employees of PRECISIONheor. Ms Pedro has nothing to disclose. Dr Hass is an employee of H. E. Outcomes, providing consulting services to Novartis. Dr Hur was an employee of Novartis at the time of this analysis. Dr Kim was a postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis at the time of this analysis. Dr Yi is an employee of Novartis. Dr Michaud received grant funding from the Rheumatology Research Foundation at the time of this analysis. This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mark Hwang
- Division of Rheumatology, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Phani Veeranki
- PRECISIONheor, Los Angeles, CA
- Optum LifeSciences, Eden Prairie, MN
| | | | | | - Jason Shafrin
- PRECISIONheor, Los Angeles, CA
- Center for Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA
| | - Sofia Pedro
- FORWARD—The National Databank for Rheumatic Diseases, Wichita, KS
| | - Steven Hass
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
- H.E. Outcomes, LLC, Los Angeles, CA
| | - Peter Hur
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
- Pfizer, Inc, New York, NY
| | - Nina Kim
- Baylor Scott and White Health, Temple, TX
- Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kaleb Michaud
- FORWARD—The National Databank for Rheumatic Diseases, Wichita, KS
- University of Nebraska Medical Center, Omaha
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13
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Chen Y, Wu C, Li Y, Chen L, Chiou H. Time Trends in Psoriasis and Psoriatic Arthritis Incidence from 2002 to 2016 in Taiwan: An Age–Period–Cohort Analysis. J Clin Med 2022; 11:3744. [PMID: 35807026 PMCID: PMC9267639 DOI: 10.3390/jcm11133744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 02/08/2023] Open
Abstract
Background: Psoriatic disease is a chronic inflammatory disease that is associated with morbidity and a poor quality of life. However, studies on the trends of psoriatic disease incidence are limited. We examined trends in psoriasis and psoriatic arthritis from 2002 to 2016 in Taiwan and distinguished the effects of age, period, and cohort on those trends. Methods: Data from the National Health Insurance Research Database were analyzed for the annual incidence of psoriasis and psoriatic arthritis. An age–period–cohort model was designed in order to investigate the effects of each age, period, and birth cohort on the incidence. Results: From 2002 to 2016, the incidence of psoriasis significantly decreased from 43.33 to 23.14 per 100,000 persons. The incidence of psoriatic arthritis significantly increased from 3.57 to 5.22 per 100,000 persons. In the age–period–cohort analysis, the net age effect on the incidence of psoriasis and psoriatic arthritis increased with advancing age (6-fold and 7.7-fold difference, respectively). Conclusion: The age–period–cohort analysis revealed that the incidence of psoriasis and psoriatic arthritis is associated with older age and early birth cohorts. Elderly individuals in Taiwan may be at a higher risk of developing new-onset psoriasis and psoriatic arthritis.
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14
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Guldberg-Møller J, Mogensen M, Ellegaard K, Zavareh A, Wakefield RJ, Tan AL, Boesen M, Dehmeshki J, Kubassova O, Dreyer L, Henriksen M, Kristensen LE. Multimodal imaging of the distal interphalangeal-joint synovio-entheseal complex in psoriatic arthritis (MIDAS): a cross-sectional study on the diagnostic accuracy of different imaging modalities comparing psoriatic arthritis to psoriasis and osteoarthritis. RMD Open 2022; 8:rmdopen-2021-002109. [PMID: 35347068 PMCID: PMC8961176 DOI: 10.1136/rmdopen-2021-002109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Can ultrasound (US), MRI and X-ray applied to the distal interphalangeal (DIP)-joint and synovio-entheseal complex (SEC) discriminate between patients with psoriatic arthritis (PsA), skin psoriasis (PsO) and hand osteoarthritis (OA)? Methods In this prospective, cross-sectional study, patients with DIP-joint PsA and nail involvement (n=50), PsO with nail involvement (n=12); and OA (n=13); were consecutively recruited. Risk ratios (RR) were calculated for US, MRI and X-ray findings of the DIP-joint and SEC between diagnoses. Results New bone formation (NBF) in US and MRI was a hallmark of OA, reducing the risk of having PsA (RR 0.52 (95% CI 0.43 to 0.63) and 0.64 (95% CI 0.56 to 0.74). The OA group was different from PsA and PsO on all MRI and X-ray outcomes reflected in a lower RR of having PsA; RR ranging from 0.20 (95% CI 0.13 to 0.31) for MRI bone marrow oedema (BMO) to 0.85 (95% CI 0.80 to 0.90) in X-ray enthesitis. No outcome in US, MRI or X-ray was significantly associated with a higher risk of PsA versus PsO, although there was a trend to a higher degree of US erosions and NBF in PsA. 82% of PsA and 67% of PsO was treated with disease modifying antirheumatic drugs which commonly reflects the clinical setting. Conclusion High grade of US, MRI and X-ray NBF reduce the RR of having PsA compared with OA. In PsA versus PsO patients, there was a trend for US to demonstrate more structural changes in PsA although this did not reach significance.
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Affiliation(s)
- Jørgen Guldberg-Møller
- The Parker Institute, Frederiksberg, Denmark .,Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Mette Mogensen
- Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark
| | | | - Ali Zavareh
- Radiology Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Richard J Wakefield
- University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Ai Lyn Tan
- University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Mikael Boesen
- Department of Radiology, Bispebjerg Hospital, Kobenhavn, Denmark
| | | | | | - Lene Dreyer
- The Parker Institute, Frederiksberg, Denmark.,Department of Rheumatology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
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15
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Tillett W, Coates LC, Kiri S, Taieb V, Willems D, Mease PJ. Achievement of more stringent disease control is associated with reduced burden on workplace and household productivity: results from long-term certolizumab pegol treatment in patients with psoriatic arthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221140846. [DOI: 10.1177/1759720x221140846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Psoriatic arthritis (PsA) impacts the physical health and functional ability of patients, leading to reduced productivity. High unemployment rates and absence due to sickness have been reported in patients with PsA. Objectives: This post hoc study investigated certolizumab pegol treatment impact on workplace and household productivity in patients with PsA, and assessed whether achievement of more stringent disease control was associated with greater improvements in productivity. Design: RAPID-PsA was a 216-week phase III trial. Methods: This post hoc study used a generalised estimating equations (GEE) model to examine the disease activity association, measured using American College of Rheumatology (ACR) and Disease Activity in PSoriatic Arthritis (DAPSA), and workplace and household productivity, assessed using an arthritis-specific Work Productivity Survey (WPS). The GEE model estimated the mean cumulative number of days patients meeting different disease control criteria were affected by absenteeism or presenteeism in the workplace and household. Results: In all, 273 patients were randomised to certolizumab pegol and 183 (67.0%) completed Week 216. At baseline, 60.8% of patients were employed outside the home. Improved disease control, measured using ACR and DAPSA criteria, was associated with fewer cumulative days affected by workplace absenteeism through Week 216: ACR70: 4.1 days, ACR50 to <70: 7.7, ACR20 to <50: 20.9, <ACR20: 35.7; DAPSA remission (REM): 3.3, low disease activity (LDA): 9.8, moderate disease activity (MoDA): 22.4, high disease activity (HDA): 54.0. Improved disease control was also associated with fewer days affected by workplace presenteeism: ACR70: 5.6, ACR50 to <70: 19.3, ACR20 to <50: 71.2, < ACR20: 141.2; DAPSA REM: 5.7, LDA: 25.8, MoDA: 77.2, HDA: 223.6. Similar associations between greater disease control and improved productivity were observed for household absenteeism and presenteeism. Conclusion: This post hoc study demonstrates the cumulative workplace and household work productivity benefits for patients with PsA when achieving more stringent thresholds of disease control with certolizumab pegol treatment.
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Affiliation(s)
- William Tillett
- Department of Pharmacy & Pharmacology, Centre for Therapeutic Innovation, University of Bath, Bath, BA13NG, UK
- Royal National Hospital for Rheumatic Diseases, Bath, BA13NG, UK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases, University of Oxford and Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | | | - Philip J. Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
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16
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Lu W, Wang Z, Soliman AM, Eldred A, Barcomb L, Behrens F. Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 1 trial. Ann Rheum Dis 2021; 81:225-231. [PMID: 34911706 PMCID: PMC8762015 DOI: 10.1136/annrheumdis-2021-221019] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/11/2021] [Indexed: 01/20/2023]
Abstract
Objective To evaluate risankizumab, a biological therapy that inhibits interleukin 23, in patients with active psoriatic arthritis (PsA) who have responded inadequately or are intolerant to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD). Methods In the randomised, placebo-controlled, double-blind KEEPsAKE 1 trial, 964 patients with active PsA were randomised (1:1) to receive risankizumab 150 mg or placebo at weeks 0, 4 and 16. The primary endpoint was the proportion of patients achieving ≥20% improvement in American College of Rheumatology criteria (ACR20) at week 24. Here, we report the results from the 24-week double-blind period; the open-label period with all patients receiving risankizumab is ongoing. Results At week 24, a significantly greater proportion of patients receiving risankizumab achieved the primary endpoint of ACR20 (57.3% vs placebo, 33.5%; p<0.001). Significant differences were also observed for risankizumab versus placebo for the first eight ranked secondary endpoints, including skin and nail psoriasis endpoints, minimal disease activity and resolution of enthesitis and dactylitis (p<0.001). Adverse events and serious adverse events were reported at similar rates in the risankizumab and placebo groups. Serious infections were reported for 1.0% and 1.2% of patients receiving risankizumab and placebo, respectively. There was one death in the risankizumab group (urosepsis deemed unrelated to the study drug). Conclusions Risankizumab treatment results in significantly greater improvement of signs and symptoms of PsA compared with placebo and is well tolerated in patients with active PsA who have responded inadequately or are intolerant to ≥1 csDMARD. Trial registration number NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research-K Papp Clinical Research, Waterloo, Ontario, Canada
| | - Leslie McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA, and Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand, and Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | - Wenjing Lu
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | - Ann Eldred
- AbbVie Inc, North Chicago, Illinois, USA
| | | | - Frank Behrens
- CIRI/Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Fraunhofer Cluster of Excellence for Immune-Mediated Disease (CIMD), Goethe University, Frankfurt, Germany
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Kelly M, Aja J, Turcotte J, MacDonald J. Effect of a PA-led arthritis center on hip and knee osteoarthritis care. JAAPA 2021; 34:42-48. [PMID: 34772855 DOI: 10.1097/01.jaa.0000800260.99283.d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of an arthritis center on patient care and operational throughput. METHODS A single-institution, retrospective review was conducted of patients with hip or knee osteoarthritis from January 2016 to October 2019. Our physician assistant (PA) led arthritis center opened in November 2017, and manages nonoperative treatment of osteoarthritis by formulating individualized treatment plans. Descriptive and inferential statistics comparing operational measures, treatment patterns, and patient satisfaction pre- and postcenter opening were performed. RESULTS Overall patient volume, new patient volume, and the proportion of new patients seen increased after the arthritis center opened. Encounters per patient and clinicians seen per patient decreased, while the rate of injections and surgery increased. Patient satisfaction improved after opening of the arthritis center. CONCLUSIONS The establishment of a dedicated PA-led arthritis center is associated with improved access to care, operational efficiency, and patient satisfaction in patients with hip and knee osteoarthritis.
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Affiliation(s)
- McKayla Kelly
- At Anne Arundel Medical Center in Annapolis, Md., McKayla Kelly is a research fellow, in the Department of Orthopedics, Jacob Aja practices in the Department of Orthopedics, Justin Turcotte is director of research in the departments of orthopedics and surgery, and James MacDonald is a surgeon in the Department of Orthopedics. Dr. MacDonald discloses that he is a paid consultant or supplier for Smith and Nephew and receives research support from Depuy, Promotus, and Smith and Nephew. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Östör A, Van den Bosch F, Papp K, Asnal C, Blanco R, Aelion J, Alperovich G, Lu W, Wang Z, Soliman AM, Eldred A, Barcomb L, Kivitz A. Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 2 trial. Ann Rheum Dis 2021; 81:351-358. [PMID: 34815219 PMCID: PMC8862056 DOI: 10.1136/annrheumdis-2021-221048] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/12/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Risankizumab is an interleukin-23 inhibitor under study for the treatment of patients with psoriatic arthritis (PsA). The phase 3 KEEPsAKE 2 trial investigated the efficacy and safety of risankizumab versus placebo in patients with active PsA who had previous inadequate response or intolerance to ≤2 biological therapies (Bio-IR) and/or ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR). Results through week 24 are reported here. METHODS Adults with PsA who were Bio-IR and/or csDMARD-IR were randomised to receive subcutaneously administered risankizumab 150 mg or placebo at weeks 0, 4 and 16 during a 24-week, double-blind treatment period. The primary endpoint was the proportion of patients who achieved ≥20% improvement in American College of Rheumatology score (ACR20) at week 24. Secondary endpoints assessed key domains of PsA and patient-reported outcomes. RESULTS A total of 444 patients (median age 53 years, range 23-84 years) were randomised to risankizumab (n=224) or placebo (n=220); 206 patients (46.5%) were Bio-IR. At week 24, a significantly greater proportion of patients receiving risankizumab achieved the primary endpoint of ACR20 (51.3% vs 26.5%, p<0.001) and all secondary endpoints (p<0.05) compared with placebo. Serious adverse events were reported for 4.0% and 5.5% of risankizumab-treated and placebo-treated patients, respectively; serious infections were reported for 0.9% and 2.3%, respectively. CONCLUSION Treatment with risankizumab resulted in significant improvements versus placebo in key disease outcomes and was well tolerated in patients with PsA who were Bio-IR and/or csDMARD-IR. TRIAL REGISTRATION NUMBER NCT03671148.
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Affiliation(s)
- Andrew Östör
- Monash Medical School, Cabrini Hospital and Emertius Research, Melbourne, Victoria, Australia
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University, VIB Center for Inflammation Research, Gent, Belgium
| | - Kim Papp
- Probity Medical Research-K Papp Clinical Research, Waterloo, Ontario, Canada
| | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Jacob Aelion
- Arthritis Clinic and West Tennessee Research Institute, Jackson, Tennessee, USA
| | | | | | | | | | | | | | - Alan Kivitz
- AbbVie Inc, North Chicago, Illinois, USA.,Altoona Center for Clinical Research, Pennsylvania, Duncansville, USA
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Skougaard M, Jørgensen TS, Jensen MJ, Ballegaard C, Guldberg-Møller J, Egeberg A, Christensen R, Benzin P, Stisen ZR, Merola JF, Coates LC, Strand V, Mease P, Kristensen LE. Change in psoriatic arthritis outcome measures impacts SF-36 physical and mental component scores differently: an observational cohort study. Rheumatol Adv Pract 2021; 5:rkab076. [PMID: 34778701 PMCID: PMC8578691 DOI: 10.1093/rap/rkab076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/28/2021] [Indexed: 01/22/2023] Open
Abstract
Objective The objective was to investigate interplay and physical and mental component scores between change (Δ) in health-related quality of life (HRQoL) quantified by the physical component score (PCS) and mental component score (MCS) retrieved from short-form health survey (SF-36), change in disease activity (ΔDAS28CRP) and manifestations of PsA. Methods PsA patients initiating new medical therapy were enrolled. Independent disease measures evaluating disease activity, enthesitis, psoriasis, pain and fatigue were collected at treatment initiation and after 4 months. Interplay between independent disease measures and dependent outcome measures, ΔPCS and ΔMCS, was described with univariate regression analyses. Multivariate regression analyses were applied to assess the impact of independent variables, such as individual disease outcome measures vs ΔDAS28CRP on ΔPCS and ΔMCS. Results One hundred and eight PsA patients were included. In the univariate regression analyses, improvement in fatigue, pain and disability were associated with improvement in ΔPCS (β; -2.08, -0.18 and -13.00, respectively; all P < 0.001) and ΔMCS (β; -1.59, -0.12 and -6.07, respectively; P < 0.001, P < 0.001 and P = 0.003, respectively). When patient-reported outcomes were included in the final multivariate models, improvements in ΔPCS and ΔMCS were associated with improvements in pain, fatigue and disability (P < 0.001). Improvement in enthesitis impacted ΔPCS positively (β -0.31, P < 0.001). No association was found between change in skin psoriasis, ΔPCS and ΔMCS (β 0.15, P = 0.056 and β 0.05, P = 0.561, respectively). Conclusion In this PsA patient cohort, diminishing pain, disability and fatigue improved PCS and MCS significantly. Changes in enthesitis and psoriasis did not grossly impact HRQoL compared with DAS28CRP. Individual PsA manifestations influence HRQoL differently, which is important clinically when targeting treatment. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT02572700.
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Affiliation(s)
- Marie Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tanja S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mia J Jensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christine Ballegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Guldberg-Møller
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Peter Benzin
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zara R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Phillip Mease
- Swedish Medical Centre/Providence St. Joseph Health and the University of Washington, Seattle, WA, USA
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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20
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Guldberg-Møller J, Henriksen M, Ellegaard K, Haedersdal M, Lazar LT, Kristensen LE, Mogensen M. Novel application of optical coherence tomography and capillaroscopy in psoriatic arthritis in relationship to psoriasis and hand osteoarthritis. Rheumatol Adv Pract 2021; 5:rkab065. [PMID: 34622126 PMCID: PMC8493103 DOI: 10.1093/rap/rkab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/18/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives Nailfold video capillaroscopy (NVC) and angiographic optical coherence tomography (OCTA) have potential in diagnosing PsA and differentiating it from psoriasis vulgaris (PsO) and hand OA. We aimed to assess the diagnostic properties of NVC and OCTA in patients with PsA compared with patients with PsO and hand OA based on nailfold capillary patterns. Methods Patients with DIP joint PsA and nail involvement (n = 50), PsO with nail involvement (n = 12) and OA (n = 13) were included in this cross-sectional study. Capillaries were evaluated semi-quantitatively and qualitatively. Differences in capillary findings between groups were assessed using mixed linear models. Binary logistic regression analyses were performed to determine the probability for PsA diagnosis based on capillaroscopy findings. Results Below mean capillary density and reduced nailfold blood flow in OCTA images distinguished PsA from both PsO (P = 0.004 and P = 0.052, respectively) and OA (P = 0.024 and P < 0.001, respectively). Qualitative analysis revealed that glomerular capillaries were found in only 3% of PsA patients but in 13% of PsO patients (P = 0.003). Furthermore, crossed vessels were seen in only 55% of PsA patients and 71% of PsO patients (P = 0.043). NVC microhaemorrhage was dominant in PsA patients (13%) and significantly different from OA patients (P <0.05). No capillary pattern was associated with an increased probability of the PsA diagnosis. Conclusion A pathognomonic pattern for PsA diagnosis was not identified; however, we demonstrated some characteristic capillaroscopy findings for PsA, such as decreased capillary density, reduced blood flow and fewer crossed vessels in OCTA and presence of NVC microhaemorrhages.
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Affiliation(s)
- Jørgen Guldberg-Møller
- The Parker Institute, Bispebjerg and Frederiksberg University Hospitals.,Department of Rheumatology, Slagelse Sygehus, Zealand University Hospitals, Slagelse
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg University Hospitals
| | - Karen Ellegaard
- The Parker Institute, Bispebjerg and Frederiksberg University Hospitals
| | - Merete Haedersdal
- Department of Dermatology, University Hospitals of Copenhagen, Bispebjerg and Frederiksberg Copenhagen, Denmark
| | - Luna T Lazar
- Department of Dermatology, University Hospitals of Copenhagen, Bispebjerg and Frederiksberg Copenhagen, Denmark
| | | | - Mette Mogensen
- Department of Dermatology, University Hospitals of Copenhagen, Bispebjerg and Frederiksberg Copenhagen, Denmark
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Marques ML, Alunno A, Boonen A, Ter Wee MM, Falzon L, Ramiro S, Putrik P. Methodological aspects of design, analysis and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis: results of two systematic literature reviews informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2020-001522. [PMID: 33542048 PMCID: PMC7868290 DOI: 10.1136/rmdopen-2020-001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To summarise the methodological aspects in studies with work participation (WP) as outcome domain in inflammatory arthritis (IA) and other chronic diseases. Methods Two systematic literature reviews (SLRs) were conducted in key electronic databases (2014–2019): search 1 focused on longitudinal prospective studies in IA and search 2 on SLRs in other chronic diseases. Two reviewers independently identified eligible studies and extracted data covering pre-defined methodological areas. Results In total, 58 studies in IA (22 randomised controlled trials, 36 longitudinal observational studies) and 24 SLRs in other chronic diseases were included. WP was the primary outcome in 26/58 (45%) studies. The methodological aspects least accounted for in IA studies were as follows (proportions of studies positively adhering to the topic are shown): aligning the studied population (16/58 (28%)) and sample size calculation (8/58 (14%)) with the work-related study objective; attribution of WP to overall health (28/58 (48%)); accounting for skewness of presenteeism/sick leave (10/52 (19%)); accounting for work-related contextual factors (25/58 (43%)); reporting attrition and its reasons (1/58 (2%)); reporting both aggregated results and proportions of individuals reaching predefined meaningful change or state (11/58 (16%)). SLRs in other chronic diseases confirmed heterogeneity and methodological flaws identified in IA studies without identifying new issues. Conclusion High methodological heterogeneity was observed in studies with WP as outcome domain. Consensus around various methodological aspects specific to WP studies is needed to improve quality of future studies. This review informs the EULAR Points to Consider for conducting and reporting studies with WP as an outcome in IA.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands .,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Umbria, Italy
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louise Falzon
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
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Atzeni F, Gerratana E, Francesco Masala I, Bongiovanni S, Sarzi-Puttini P, Rodríguez-Carrio J. Psoriatic Arthritis and Metabolic Syndrome: Is There a Role for Disease Modifying Anti-Rheumatic Drugs? Front Med (Lausanne) 2021; 8:735150. [PMID: 34527685 PMCID: PMC8435605 DOI: 10.3389/fmed.2021.735150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/09/2023] Open
Abstract
Although psoriatic arthritis (PsA) primarily leads to joint and skin damage, it is associated with higher prevalence of metabolic syndrome (MetS) and its components, namely hypertension, dyslipidemia, obesity, and type II diabetes. Additionally, chronic inflammation is known to aggravate these cardiometabolic factors, thus explaining the enhanced cardiovascular (CV) morbidity and mortality in RA. Furthermore, emerging evidence suggest that some risk factors can fuel inflammation, thus pointing to a bidirectional crosstalk between inflammation and cardiometabolic factors. Therefore, dampening inflammation by disease-modifying anti-rheumatic drugs (DMARDs) may be thought to ameliorate MetS burden and thus, CV risk and disease severity. In fact, recommendations for PsA management emphasize the need of considering comorbidities to guide the treatment decision process. However, the existing evidence on the impact of approved DMARDs in PsA on MetS and MetS components is far from being optimal, thus representing a major challenge for the clinical setting. Although a beneficial effect of some DMARDs such as methotrexate, TNF inhibitors and some small molecules is clear, no head-to-head studies are published and no evidence is available for other therapeutic approaches such as IL-23 or IL-17 inhibitors. This narrative review summarizes the main evidence related to the effect of DMARDs on MetS outcomes in PsA patients and identify the main limitations, research needs and future perspectives in this scenario.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy,*Correspondence: Fabiola Atzeni
| | - Elisabetta Gerratana
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | | | - Sara Bongiovanni
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Javier Rodríguez-Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain,Area of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Häbel H, Wettermark B, Hägg D, Villacorta R, Wennerström ECM, Linder M. Societal impact for patients with psoriasis: A nationwide Swedish register study. JAAD Int 2021; 3:63-75. [PMID: 34409373 DOI: 10.1016/j.jdin.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background Psoriasis is an immune-mediated chronic inflammatory disease having a significant negative health impact. Psoriasis has societal impact; loss of productivity has been estimated at approximately 10% and it may influence the patient's financial status. Relationships between quality of life, disease severity, and cost of care need exploration. Understanding the disease burden is important for health policy and research allocation. Few studies address the research gaps in socioeconomics, comorbidity, and medication use. Objective Observing differences in education, income, employment status, marital status, health care consumption, and drug utilization between patients with psoriasis and matched controls. Methods Cohort study following socioeconomics and health care consumption for all psoriasis patients from the Swedish patient register. All individuals with a first diagnosis of psoriasis in outpatient or inpatient care from 2002 to 2013 were followed until death, emigration, or end of the study. Results Overall, 109,803 patients were included (mean age 51.2 years, 53% women) and matched with 1.08 million controls. The levels of education and income were similar, but the proportion employed was significantly lower for patients with psoriasis. There was a tendency for fewer patients with psoriasis to be married. Limitations Generalizability, lack of primary care diagnoses, and lack of early treatments (available from 2005). Conclusion Understanding of the socioeconomic impact of psoriasis is extended by showing reductions in employment.
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FitzGerald O, Ogdie A, Chandran V, Coates LC, Kavanaugh A, Tillett W, Leung YY, deWit M, Scher JU, Mease PJ. Psoriatic arthritis. Nat Rev Dis Primers 2021; 7:59. [PMID: 34385474 DOI: 10.1038/s41572-021-00293-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Psoriatic arthritis (PsA) is a complex inflammatory disease with heterogeneous clinical features, which complicates psoriasis in 30% of patients. There are no diagnostic criteria or tests available. Diagnosis is most commonly made by identifying inflammatory musculoskeletal features in joints, entheses or the spine in the presence of skin and/or nail psoriasis and in the usual absence of rheumatoid factor and anti-cyclic citrullinated peptide. The evolution of psoriasis to PsA may occur in stages, although the mechanisms are unclear. In many patients, there may be little or no relationship between severity of musculoskeletal inflammation and severity of skin or nail psoriasis. The reason for this disease heterogeneity may be explained by differences in genotype, especially in the HLA region. New targeted therapies for PsA have been approved with additional therapies in development. These developments have substantially improved both short-term and long-term outcomes including a reduction in musculoskeletal and skin manifestations and in radiographic damage. With efforts underway aimed at improving our understanding of the molecular basis for the heterogeneity of PsA, a personalized approach to treating PsA may become possible.
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Ballegaard C, Skougaard M, Guldberg-Møller J, Nissen CV, Amris K, Jørgensen TS, Dreyer L, Kristensen LE. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford) 2021; 60:3289-3300. [PMID: 33325531 DOI: 10.1093/rheumatology/keaa780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the prognostic value of pre-specified comorbidities on treatment outcomes in PsA, and to compare baseline data with cutaneous psoriasis without arthritis and healthy controls (HC). METHODS Patients initiating conventional synthetic/biological disease-modifying antirheumatic drugs were enrolled in this clinical observational cohort study, and data on comorbidities, and clinical and patient-reported outcomes were retrieved at baseline and after 4 months. Pearson's chi-squared tests were performed to investigate the prognostic value of pre-specified comorbidities and achievement of ACR20, DAPSA50 and MDA. Mann-Whitney U tests were used to compare OMERACT PsA Core Outcome Set (COS) measures at baseline and follow-up for the pre-specified comorbidities. RESULTS A total of 100 PsA patients were included at baseline. Statistically significantly fewer patients with obesity achieved DAPSA50 compared with patients without obesity (P =0.035), and fewer patients with hypertension (P =0.034) and Charlson Comorbidity Index (CCI) ≥1 (P =0.027), respectively, achieved MDA compared with patients without these comorbidities. Patients with obesity, hypertension, widespread pain, and CCI ≥1 had significantly worse COS measures at follow-up compared with patients without these comorbidities. At baseline, patients with PsA had higher disease burden compared with patients with cutaneous psoriasis and HC, including higher pain (P <0.001) and fatigue (P <0.001) scores, and more widespread pain (P =0.002). CONCLUSION Obesity, hypertension and CCI ≥1 were prognostic factors for poorer treatment outcome rates in PsA. Pain and fatigue were more frequently reported among patients with PsA compared with patients with cutaneous psoriasis and HC. TRIAL REGISTRATION The Danish National Committee on Health Research Ethics: H-15009080; Data Protection Agency: 2012-58-0004; ClinicalTrials.gov: NCT02572700.
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Affiliation(s)
- Christine Ballegaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marie Skougaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jørgen Guldberg-Møller
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christoffer V Nissen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kirstine Amris
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Tanja S Jørgensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars E Kristensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Haugeberg G, Michelsen B, Kavanaugh A. Impact of skin, musculoskeletal and psychosocial aspects on quality of life in psoriatic arthritis patients: A cross-sectional study of outpatient clinic patients in the biologic treatment era. RMD Open 2021; 6:rmdopen-2020-001223. [PMID: 32409518 PMCID: PMC7299507 DOI: 10.1136/rmdopen-2020-001223] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA), both psoriasis and musculoskeletal manifestations may impair Health-Related Quality of Life (HRQoL). Our objective was to explore the impact of the various disease manifestations and disease consequences, including psychosocial factors, on HRQoL in PsA patients treated in the biologic treatment era. METHODS Data collection in the 131 outpatient clinic PsA patients assessed included demographics, disease activity measures for both skin and musculoskeletal involvement and patient-reported outcome (PRO) measures, treatment and psychosocial burden. The skin dimension of quality of life was assessed by the Dermatology Life Quality Index (DLQI) and the overall HRQoL by the 15-Dimensional (15D) Questionnaire. RESULTS The mean age was 51.9 years, PsA disease duration 8.6 years, 50.4% were men, 56.9% were employed/working and 47.7% had ≥1 comorbidities. Prevalence of monotherapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was 36.6% and with biologic DMARDs 12.2% and combination of both 22.9%. Mean DLQI was 3.3 and 15D 0.84. In adjusted analysis, not employed/working, higher scores for fatigue, sleep disturbances, anxiety and depression, Modified Health Assessment Questionnaire and presence of comorbidities were independently associated with impaired HRQoL (lower 15D scores), whereas Psoriasis Area Severity Index (PASI) and DLQI were not. Younger age and higher Psoriatic Arthritis Disease Activity Score and PASI scores were independently associated with impaired skin quality of life (higher DLQI score). CONCLUSION Our study highlights the negative impact the psychosocial burden, impaired physical function and comorbidities has on reduced HRQoL in PsA outpatients. Thus, to further improve HRQoL in PsA patients, not only physical concerns but also psychological concerns need to be addressed.
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Affiliation(s)
- Glenn Haugeberg
- Division of Rheumatology, Dept. of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
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Lund Hansen R, Schoedt Jørgensen T, Dreyer L, Hetland ML, Glintborg B, Askling J, Di Giuseppe D, Jacobsson LTH, Wallman JK, Nordstrom D, Aaltonen K, Kristianslund EK, Kvien TK, Provan SA, Gudbjornsson B, Love TJ, Kristensen LE. Inflammatory hallmarks of lesser prominence in psoriatic arthritis patients starting biologics: a Nordic population-based cohort study. Rheumatology (Oxford) 2021; 60:140-146. [PMID: 32591790 DOI: 10.1093/rheumatology/keaa237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess secular trends in baseline characteristics of PsA patients initiating their first or subsequent biologic DMARD (bDMARD) therapy and to explore prescription patterns and treatment rates of bDMARDs from 2006 to 2017 in the Nordic countries. METHODS PsA patients registered in the Nordic rheumatology registries initiating any treatment with bDMARDs were identified. The bDMARDs were grouped as original TNF inhibitor [TNFi; adalimumab (ADA), etanercept (ETN) and infliximab (IFX)]; certolizumab pegol (CZP) and golimumab (GOL); biosimilars and ustekinumab, based on the date of release. Baseline characteristics were compared for the five countries, supplemented by secular trends with R2 calculations and point prevalence of bDMARD treatment. RESULTS A total of 18 089 patients were identified (Denmark, 4361; Iceland, 449; Norway, 1948; Finland, 1069; Sweden, 10 262). A total of 54% of the patients were female, 34.3% of patients initiated an original TNFi, 8% CZP and GOL, 7.5% biosimilars and 0.3% ustekinumab as a first-line bDMARD. Subsequent bDMARDs were 25.2% original TNFi, 9% CZP and GOL, 12% biosimilars and 2.1% ustekinumab. From 2015 through 2017 there was a rapid uptake of biosimilars. The total of first-line bDMARD initiators with lower disease activity increased from 2006 to 2017, where an R2 close to 1 showed a strong association. CONCLUSION Across the Nordic countries, the number of prescribed bDMARDs increased from 2006 to 2017, indicating a previously unmet need for bDMARDs in the PsA population. In recent years, PsA patients have initiated bDMARDs with lower disease activity compared with previous years, suggesting that bDMARDs are initiated in patients with a less active inflammatory phenotype.
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Affiliation(s)
- Rebekka Lund Hansen
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen
| | | | - Lene Dreyer
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen.,Department of Rheumatology, Aalborg University Hospital, Aalborg
| | - Merete L Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Lennart T H Jacobsson
- Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden
| | - Dan Nordstrom
- ROB-FIN, Division of Medicine, Helsinki University Hospital and Helsinki University
| | - Kalle Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital, Faculty of Medicine, University of Iceland
| | - Thorvadur J Love
- University of Iceland and Landspitali University Hospital, Reykjavik, Iceland
| | - L E Kristensen
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen
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Sewerin P, Borchert K, Meise D, Schneider M, Mahlich J. Health resource utilization and associated healthcare costs of biologic disease modifying antirheumatic drugs in German patients with psoriatic arthritis. Arthritis Care Res (Hoboken) 2021; 74:1435-1443. [PMID: 33742791 DOI: 10.1002/acr.24598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate healthcare costs associated with biologic disease-modifying antirheumatic drugs (bDMARDs) in a German real-world cohort of adult biologic-naïve patients with psoriatic arthritis (PsA). METHODS Claims data from the InGef research database for patients with a PsA diagnosis and bDMARD claims record (index date) between January 1st , 2014 and December 31st , 2017; and no bDMARD prescription for 365 days before the index date, were retrospectively analyzed. Primary outcomes were determination of healthcare resource utilization (HRU) and associated annual healthcare costs for overall and individual bDMARDs in the 12-month pre- and post-index periods. These outcomes were compared between persistent and non-persistent groups. Non-persistence was defined as treatment gap or switch to bDMARD other than the index therapy. RESULTS Among 10,954 patients with a PsA diagnosis, 348 were eligible. Although mean (SD) post-index costs were significantly higher in the persistent group than the non-persistent group (€27,869 [8,001] vs. €21,897 [10,600]; P<0.001) due to higher bDMARD acquisition costs (€23,996 [4,818] vs. €16,427 [9,033]; P<0.001), persistence reduced inpatient treatment costs (-€760), outpatient treatment costs (-€192), other drug costs (-€724), and sick leave costs (-€601). CONCLUSION Although initiation of bDMARDs increased the total healthcare costs irrespective of persistence status, partial cost offsets were observed in the persistent patient population.
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Affiliation(s)
- Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | | | | | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Mahlich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany.,Düsseldorf Institute of Competition Economics (DICE), University of Düsseldorf, Germany
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Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21998279. [PMID: 33737966 PMCID: PMC7934027 DOI: 10.1177/1759720x21998279] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of cardiometabolic disorders, such as hypertension, dyslipidemia, diabetes, obesity, and cardiovascular disease (CVD), compared with the general population. These comorbidities are associated with the severity of disease, and adversely affect treatment outcomes in PsA. Comorbidities lead to increased physician visits and medications for patients and make the selection and maintenance of therapies challenging for physicians. Moreover, CVD is a leading cause of mortality in PsA. Therefore, optimal management of PsA should include not only treating the skin and joint disease, but also identifying comorbidities early, and managing them to improve long-term outcomes. Further studies are needed to understand the complex mechanisms, interactions, and trajectories of cardiometabolic comorbidities in psoriatic disease.
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Affiliation(s)
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lihi Eder
- Department of Medicine/Rheumatology, Women's College Hospital, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
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Gupta S, Syrimi Z, Hughes DM, Zhao SS. Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int 2021; 41:275-284. [PMID: 33423070 PMCID: PMC7835184 DOI: 10.1007/s00296-020-04775-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022]
Abstract
The aims of this systematic review and meta-analysis were to: (1) describe the prevalence of commonly reported comorbidities in psoriatic arthritis (PsA), (2) compare the incidence and/or prevalence of comorbidities between PsA and control populations; and (3) examine the impact of comorbidities on PsA outcomes. We systematically searched Medline, PubMed, Scopus, and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Studies reporting only one comorbidity, or a few closely related diseases within one organ system, were excluded. Where possible, meta-analysis was performed using random-effects models. We included 39 studies amounting to over 152 thousand PsA patients. We performed meta-analysis for the prevalence of 21 commonly reported comorbidities. The most prevalent comorbidities were hypertension (pooled prevalence 34%), metabolic syndrome (29%), obesity (27%), hyperlipidaemia (24%) and any cardiovascular diseases (19%). Eleven studies consistently showed higher prevalence of comorbidities in PsA than controls. Five studies showed that comorbid patients had more severe disease, poorer quality of life, and increased discontinuation of treatment. Comorbidities, particularly cardiometabolic disorders, were highly prevalent in PsA and more common than in healthy controls. Comorbidities were associated with adverse disease features, but more research is needed on their impact on longitudinal outcomes such as treatment response, work productivity and mortality.
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Affiliation(s)
- Sonal Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Zoe Syrimi
- Department of Medicine, Liverpool University Hospitals, Liverpool, UK
| | - David M Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sizheng Steven Zhao
- Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3GA, UK.
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Haugeberg G, Lund Nilsen TI, Kavanaugh A, Thomsen RS, Gulati AM, Hoff M. Physical and Psychosocial Burden of Psoriatic Arthritis: Longitudinal Data From a Population-Based Study in Norway. Arthritis Care Res (Hoboken) 2020; 73:138-145. [PMID: 33242358 DOI: 10.1002/acr.24412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) can have a significant impact on health-related quality of life (HRQoL). Data on the timing of changes in the HRQoL of patients with PsA are limited. The present study was undertaken to explore associations between sleep disturbance, fatigue, pain, anxiety, depression, general health status, and satisfaction with life before and after a diagnosis of PsA compared to the general population. METHODS Patients diagnosed with PsA between the Nord-Trøndelag Health Study (HUNT2 [1995-1997] and HUNT3 [2006-2008]) surveys were compared to the general population. The adjusted odds ratio (ORadj ) with 95% confidence interval (95% CI) was estimated at both time points. RESULTS Among 36,507 individuals participating in both the HUNT2 and HUNT3 surveys, 160 were diagnosed with PsA between the surveys. The prevalence of sleep disturbances and fatigue was higher in PsA patients after diagnosis compared to the general population (ORadj 2.24 [95% CI 1.55-3.25] and ORadj 1.94 [95% CI 1.27-2.98], respectively). The prevalence of pain and poor health status were higher in patients with PsA compared with the general population even before PsA was diagnosed (ORadj 2.81 [95% CI 1.96-4.02] and ORadj 3.08 [95% CI 2.19-4.35], respectively) and increased after diagnosis of PsA (ORadj 12.87 [95% CI 6.27-26.40] and ORadj 5.63 [95% CI 3.99-7.95], respectively). For anxiety, depression, and life satisfaction, patients who developed PsA were comparable to the general population both before and after the diagnosis of PsA. CONCLUSION Compared to the general population, PsA patients reported a higher prevalence of pain and poorer health status before diagnosis. Increased prevalence of sleep disturbances and fatigue in PsA patients was only found after the PsA diagnosis, and no differences between patients with PsA and the control group were found for anxiety and depression.
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Affiliation(s)
- Glenn Haugeberg
- Sorlandet Hospital, Kristiansand, and Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | | | | | - Mari Hoff
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Jørgensen TS, Skougaard M, Hansen RL, Ballegaard C, Mease P, Strand V, Dreyer L, Kristensen LE. Relation Between Fatigue and ACR Response in Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitor Therapy: A Population-based Cohort Study. J Rheumatol 2020; 48:829-835. [PMID: 33191280 DOI: 10.3899/jrheum.191107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this population-based cohort study was to investigate the association between fatigue with disease activity and drug survival in patients with psoriatic arthritis (PsA) receiving their first tumor necrosis factor inhibitor (TNFi). METHODS Data on patient characteristics, disease activity, and drug survival were obtained from the DANBIO database on all patients with PsA from 2006 through 2015. Information on comorbidities was obtained through linkage with the Danish National Patient Registry. RESULTS A total of 880 patients were eligible for analyses. Patients with upper median fatigue scores had statistically significant higher disease activity measures (Disease Activity Score in 28 joints based on C-reactive protein), pain, and Health Assessment Questionnaire (HAQ) scores; tender joint counts; comorbidities (Charlson Comorbidity Index ≥ 2); and current smoking status at baseline compared to patients with lower median fatigue scores (P < 0.05). In the upper median fatigue group, fewer patients achieved American College of Rheumatology (ACR) responses and improvements in visual analog scale (VAS) fatigue compared to patients in the lower median fatigue group. Kaplan-Meier curves showed shorter drug survival in patients in the upper median fatigue group compared with the lower median fatigue group at 6-month follow-up. CONCLUSION Fatigue remains a dominating symptom after TNFi treatment, and is associated with higher baseline disease activity, pain, and HAQ scores; more comorbidities; and increased risk of TNFi treatment discontinuation in a cohort of Danish patients with PsA. The agreement between ACR and VAS fatigue responses is weak to moderate, suggesting heterogeneity between experienced fatigue and joint inflammation.
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Affiliation(s)
- Tanja Schjødt Jørgensen
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark;
| | - Marie Skougaard
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Rebekka Lund Hansen
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Christine Ballegaard
- C. Ballegaard, MD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, and DANBIO Registry, Gentofte Hospital, Rigshospitalet, Hellerup, Denmark
| | - Philip Mease
- P. Mease, MD, Clinical Professor, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Vibeke Strand
- V. Strand, MD, Clinical Professor, Division Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | - Lene Dreyer
- L. Dreyer, MD, Professor, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, DANBIO Registry, Gentofte Hospital, Rigshospitalet, Hellerup, and Departments of Rheumatology and Clinical Medicine, Aalborg University Hospital and Aalborg University, Aalborg, Denmark
| | - Lars Erik Kristensen
- T.S. Jørgensen, MSc, PhD, Senior Researcher, M. Skougaard, MD, R.L. Hansen, medical student, L.E. Kristensen, MD, PhD, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
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Thomsen SF, Skov L, Kristensen LE, Hedegaard MS, Kjellberg J, Jørgensen TS, Brenøe S, Dodge R. Incentives for Danish healthcare management based on a pilot outcome-based, patient-centric management model in psoriasis and psoriatic arthritis: the non-interventional IMPROVE study. ACTA ACUST UNITED AC 2020; 78:95. [PMID: 33062265 PMCID: PMC7552477 DOI: 10.1186/s13690-020-00479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022]
Abstract
Background Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients’ quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA. Methods The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1–3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark. Results Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important ‘clusters’ of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely. Conclusion The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems. Trial registration Not applicable; data collected from patient registries in Denmark.
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Affiliation(s)
- Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | | | | | - Tanja Schjødt Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | | | - Rikke Dodge
- Novartis Healthcare A/S, Copenhagen, Denmark
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Batko B. Patient-Centered Care in Psoriatic Arthritis-A Perspective on Inflammation, Disease Activity, and Psychosocial Factors. J Clin Med 2020; 9:E3103. [PMID: 32992983 DOI: 10.3390/jcm9103103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. Patients with PsA suffer from a variety of psychosocial difficulties and nonspecific symptoms early on in the disease course and continue to experience progressive disease due to delays in diagnosis and treatment. Symptoms initially viewed as somatization could lead to undertreatment and promote psychological distress, poor coping, and negative patient-provider relationships. Pain and fatigue are important complaints that affect the patient's perception and may need to be addressed with a multidisciplinary approach. Maladaptive cognitive responses can lead to a negative illness perception and impact patient beliefs and concerns over treatment, as well as nonadherence. An underlying inflammatory component in affective disorders has been examined, though whether and how it may interact mechanistically in PsA warrants interest. Cognitive behavioral therapy represents a nonpharmacological treatment modality that can be combined with cytokine-targeted therapy to address both somatic and psychological complaints. Future directions for research include: (1) Elucidating nonspecific manifestations (e.g., subclinical stage, differential with functional syndromes) of PsA and how they impact diagnosis and management; (2) characterizing immune-mediated components of mood disorders in PsA; and (3) whether a bidirectional approach with abrogating inflammation and psychotherapeutic support leads to improved outcomes.
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Xie W, Huang H, Deng X, Gao D, Zhang Z. Modifiable lifestyle and environmental factors associated with onset of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational studies. J Am Acad Dermatol 2020; 84:701-711. [PMID: 32827608 DOI: 10.1016/j.jaad.2020.08.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/13/2020] [Accepted: 08/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a progressive joint disease associated with psoriasis. OBJECTIVES To investigate the association of modifiable lifestyle and environmental factors with PsA risk among people with psoriasis. METHODS We conducted a systematic search of PubMed, Embase, and Cochrane Library through May 2, 2020, for observational studies reporting lifestyle or environmental factors for PsA onset in patients with psoriasis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were combined using a random-effects model. RESULTS We included 16 studies comprising 322,967 individuals. Obesity and being overweight were associated with an increased PsA risk in patients with psoriasis (OR, 1.75 [95% CI, 1.42-2.16] and OR, 1.50 [95% CI, 1.08-2.09], respectively), with an increase of approximately 6% for each kg/m2 rise in body mass index (OR, 1.06; 95% CI, 1.03-1.10). The presence of PsA was associated with a history of physical trauma (OR, 1.33; 95% CI, 1.16-1.54) or fracture (OR, 1.46; 95% CI, 1.22-1.74). No significant associations were observed regarding alcohol consumption (OR, 0.99; 95% CI, 0.88-1.13), smoking (OR, 0.89; 95% CI, 0.75-1.06), female hormonal exposure (OR, 1.45; 95% CI, 0.95-2.20), and psychologically traumatic events. LIMITATIONS Inherent limitations in the included observational studies. CONCLUSIONS Several lifestyle and environmental factors are associated with PsA onset among patients with psoriasis. These findings indicate that such risk may be modified with lifestyle changes or avoidance of physical trauma in people with psoriasis.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Dai Gao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China.
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Ørts LM, Bech BH, Lauritzen T, Carlsen AH, Sandbæk A, Løkke A. Lung function in adults and future burden of obstructive lung diseases in a long-term follow-up. NPJ Prim Care Respir Med 2020; 30:10. [PMID: 32218439 PMCID: PMC7099055 DOI: 10.1038/s41533-020-0169-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Abstract
Spirometry is recommended in symptomatic smokers to identify obstructive lung diseases. However, it is unknown whether there are certain characteristics that can be used to identify the individual risk of developing obstructive lung diseases. The aim of this study was to examine the association between lung function in adults and burden of lung diseases throughout 27 years of follow-up. We performed a cohort study among individuals aged 30–49 years at baseline (1991). Spirometry measurements were divided into three groups: (1) FEV1/FVC < 70, (2) FEV1/FVC: 70–75, (3) FEV1/FVC > 75 (reference). Using negative binominal regression, the burden of lung diseases was measured by contacts to general practice, hospitalisations, redeemed respiratory medicine and socioeconomic parameters between 1991 and 2017. A total of 905 citizens were included; mean age of 40.3 years, 47.5% were males and 51.2% were smokers at baseline. The group with an FEV1/FVC: 70–75 received more respiratory medicine (IRR = 3.37 (95% CI: 2.69–4.23)), had lower income (IRR = 0.96 (95% CI: 0.93–0.98)), and had more contacts to general practice (IRR = 1.14 (95% CI: 1.07–1.21)) and hospitals for lung diseases (IRR = 2.39 (95% CI: 1.96–5.85)) compared to the reference group. We found an association between lung function and the future burden of lung diseases throughout 27 years of follow-up. In particular, adults with an FEV1/FVC: 70–75 need extra attention in the case finding.
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Affiliation(s)
- Lene Maria Ørts
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Torsten Lauritzen
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Annelli Sandbæk
- Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anders Løkke
- Department of Medicine, Hospital Little Belt, Vejle, Denmark
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Trettin B, Feldman SR, Andersen F, Danbjørg DB, Agerskov H. A changed life: the life experiences of patients with psoriasis receiving biological treatment. Br J Dermatol 2020; 183:516-523. [PMID: 31953845 DOI: 10.1111/bjd.18876] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Psoriasis has a large negative impact on quality of life and is associated with both depression and anxiety. The introduction of biologics has improved treatment outcomes, but the ways in which patients perceive these improvements are not well characterized. OBJECTIVES To investigate the everyday life experiences of patients with psoriasis receiving biological treatment in order to gain an understanding of their needs and to improve the quality of care. METHODS A qualitative narrative methodology was utilized. In total 48 h of participant observations during consultations, and 15 semistructured interviews, were conducted with patients receiving biological treatment. Data were analysed according to Ricoeur's theory of interpretation. RESULTS Receiving biological treatment was experienced as a turning point, with a significant impact on physical, psychological and emotional levels. However, psychological consequences, such as isolation and social withdrawal, seemed to be a part of the patient's identity; the negative perceptions of psoriasis left marks behind that affected the patient's self-image. Perceived fear of discontinuation of the biological treatment resulted in insecurity, and patients were reluctant to initiate discussion about these concerns with healthcare professionals. CONCLUSIONS Providing assistance when patients enter the transition of receiving biological treatment may be important. Patients' fear of biological treatment being discontinued is an ongoing issue that healthcare professionals could address.
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Affiliation(s)
- B Trettin
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S R Feldman
- Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
| | - F Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Private Hospital, Molholm, Denmark
| | - D B Danbjørg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Eder L, Tu K, Rosen CF, Alhusayen R, Cheng SY, Young J, Campbell W, Bernatsky S, Gladman DD, Paterson JM, Widdifield J. Health Care Utilization for Musculoskeletal Issues During the Prediagnosis Period in Psoriatic Arthritis: A Population-Based Study. Arthritis Care Res (Hoboken) 2020; 73:680-686. [PMID: 31961491 DOI: 10.1002/acr.24146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Information about the prediagnosis period in psoriatic arthritis (PsA) is limited. The present study was undertaken to compare health care utilization related to musculoskeletal issues during a 5-year period prior to the diagnosis of PsA versus that of subjects with no prior inflammatory arthritis within a primary care setting. METHODS We conducted a population-based, matched cohort study using electronic medical records and administrative data in Ontario, Canada. Age- and sex-matched cohorts of PsA patients and comparators from the same family physicians were assembled. Comparators were not allowed to have prior spondyloarthritis, ankylosing spondylitis, or rheumatoid arthritis billing code diagnoses. The study outcomes included health care utilization and costs related to nonspecific musculoskeletal issues during a 5-year period prior to the index date. RESULTS We studied 462 PsA patients and 2,310 matched comparators. The odds ratio (OR) related to visiting a primary care physician for nonspecific musculoskeletal issues in patients with PsA was 2.14 (95% confidence interval 1.73-2.64) in the year immediately preceding the index date and was similarly elevated up to 5 years prior. The OR related to using other musculoskeletal-related health care services, including musculoskeletal specialists visits, joint injections, joint imaging, and emergency department visits, was higher in PsA as early as 5 years preceding the index date. Total and musculoskeletal-related health care costs prior to the index date were higher for patients with PsA versus comparators. CONCLUSION A prodromal PsA phase characterized by nonspecific musculoskeletal symptoms may exist. Further study is needed to determine if this represents a window for earlier diagnosis of PsA.
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Affiliation(s)
- Lihi Eder
- University of Toronto and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- North York General Hospital, University of Toronto and Toronto Western Hospital Family Health Team-University Health Network, Toronto, Ontario, Canada
| | - Cheryl F Rosen
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Raed Alhusayen
- University of Toronto and Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Stephanie Y Cheng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Dafna D Gladman
- University of Toronto and Krembil Research Institute, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - J Michael Paterson
- University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jessica Widdifield
- University of Toronto, Sunnybrook Research Institute, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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McHugh N, Maguire Á, Handel I, Tillett W, Morris J, Hawkins N, Cavill C, Korendowych E, Mughal F. Evaluation of the Economic Burden of Psoriatic Arthritis and the Relationship Between Functional Status and Healthcare Costs. J Rheumatol 2019; 47:701-707. [PMID: 31416922 DOI: 10.3899/jrheum.190083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This analysis aimed to evaluate the economic burden of patients with psoriatic arthritis (PsA) on the UK healthcare system and estimate the relationship between functional status and direct healthcare costs. METHODS Functional status [measured using the Health Assessment Questionnaire-Disability Index (HAQ-DI)], demographics, disease history, and healthcare resource use data were extracted from a cohort of patients at the Royal National Hospital for Rheumatic Diseases, Bath, UK. Each resource use item per patient was then allocated a unit cost. Linear regression models were used to predict costs as a function of HAQ-DI. Medication costs were not included in the primary analysis, which was carried out from the UK National Health Service perspective. RESULTS Data were available for 101 patients. Mean HAQ-DI score was 0.84 (SD 0.75) and mean age at HAQ-DI measurement was 57.8 (SD 10.7). Total annual healthcare costs per patient, excluding medication costs, ranged between £174 and £8854, with a mean of £1586 (SD £1639). A 1-point increase in HAQ-DI score was associated with an increase in total costs of £547.49 (standard error £224), with secondary care consultations appearing to be the primary factor. Subgroup analyses suggested higher cost increases in patients with HAQ-DI scores of 2-3 and with a disease duration > 10 years. CONCLUSION Patients with PsA place a significant economic burden on the healthcare system. Functional status is highly correlated with costs and appears to be driven mainly by the cost of secondary care consultations. Results were similar to previous studies in rheumatoid arthritis populations.
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Affiliation(s)
- Neil McHugh
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK. .,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted. .,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly).
| | - Áine Maguire
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Ian Handel
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - William Tillett
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - James Morris
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Neil Hawkins
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Charlotte Cavill
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Eleanor Korendowych
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Farhan Mughal
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
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Guldberg-Møller J, Cordtz RL, Kristensen LE, Dreyer L. Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark. Ann Rheum Dis 2019; 78:1517-1523. [PMID: 31300461 DOI: 10.1136/annrheumdis-2019-215313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate time-trends and cumulative incidence of joint surgery among patients with psoriatic arthritis (PsA) compared with the general population. METHODS In this nationwide register-based cohort study, The Danish National Patient Registry was used to identify incident PsA patients. The 5-year incidence rates (IR) and incidence rate ratios (IRR) of joint surgery were calculated in four calendar-period defined cohorts. Each patient was matched with ten non-PsA individuals from the general population cohort (GPC). The cumulative incidences of any joint and joint-sacrificing surgery, respectively, were estimated using the Aalen-Johansen method. RESULTS From 1996 to 2017, 11 960 PsA patients (mean age 50 years; 57% female) were registered. The IRR of any joint surgery was twice as high for PsA patients compared with GPCs across all calendar periods. Among patients with PsA, 2, 10 and 29% required joint surgery at 5, 10 and 15 years after diagnosis. The risk of surgery in PsA patients diagnosed at 18-40 years was higher (22%) than in GPC 60+ year old (20%) after 15 years of follow-up. CONCLUSIONS The use of joint surgery among PsA patients remained around twofold higher from 1996 to 2012 compared with GPC. After 15 years of follow-up, nearly 30% of the PsA patients had received any surgery, and even a person diagnosed with PsA at the age of 18-40 years had a higher risk of surgery than GPCs of 60+ year old. Thus, the high surgical rates represent an unmet need in the current treatment of PsA.
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Affiliation(s)
- Jørgen Guldberg-Møller
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, The Parker Institute, Frederiksberg, Denmark .,Department of Rheumatology, Slagelse Sygehus, Slagelse, Denmark
| | - Rene Lindholm Cordtz
- Center for Rheumatology and Spine Diseases - Gentofte, Rigshospitalet, Hellerup, Denmark
| | | | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Mars NJ, Kerola AM, Kauppi MJ, Pirinen M, Elonheimo O, Sokka-Isler T. Patients with rheumatic diseases share similar patterns of healthcare resource utilization. Scand J Rheumatol 2019; 48:300-307. [PMID: 30836033 DOI: 10.1080/03009742.2018.1559878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.
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Affiliation(s)
- N J Mars
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland
| | - A M Kerola
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - M J Kauppi
- c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland.,d School of Medicine , University of Tampere , Tampere , Finland
| | - M Pirinen
- b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland.,e Helsinki Institute for Information Technology HIIT and Department of Mathematics and Statistics , University of Helsinki , Helsinki , Finland.,f Department of Public Health , University of Helsinki , Helsinki , Finland
| | - O Elonheimo
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - T Sokka-Isler
- g Department of Medicine , Jyväskylä Central Hospital , Jyväskylä , Finland
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Scher JU, Ogdie A, Merola JF, Ritchlin C. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol 2019; 15:153-66. [DOI: 10.1038/s41584-019-0175-0] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Degli Esposti L, Perrone V, Sangiorgi D, Alessandrini D, Buda S, Cantini F, Mazzini E, Toma C, De Solda F. Therapeutic strategies utilization and resource consumption in patients treated for psoriatic arthritis: findings from a real-world analysis in an Italian setting. Patient Prefer Adherence 2019; 13:187-194. [PMID: 30774314 PMCID: PMC6348972 DOI: 10.2147/ppa.s178603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The purpose of this study was to analyze the therapeutic strategies and estimate the health care resource consumption in patients with psoriatic arthritis (PsA). PATIENTS AND METHODS An observational retrospective cohort analysis of administrative databases of six Italian Local Health Units was performed. Patients ≥18 years with a hospitalization discharge diagnosis of PsA (International Classification of Diseases, Ninth Revision code: 696.0) or exemption code (045.696.0) for PsA from January 1, 2010 to December 31, 2015 (inclusion period), with at least one prescription of any therapy used for PsA were included. The index date (ID) was the first date matching with at least one of the inclusion criteria during the inclusion period. All patients were followed up after the ID until the end of data availability. Baseline C-reactive protein (CRP) levels (±6 months in relation to the ID) were also analyzed. RESULTS A total of 2,408 (prevalence 0.83 per 1,000) patients with PsA (male 52%; median age 54 years) were included in the study; patients were already treated for PsA in 42.4% of cases. At 1 year of follow-up, 73% of the patients received one systemic drug, while 22% of patients received two systemic drugs; in addition, our results show an increase in the number of add-on or switches in a longer follow-up period. The utilization of biologic agents was higher among patients with previous PsA treatment, showing a progression of the pathology. Overall, a medium/high level of CRP at baseline was observed among more than half of the overall sample, with slight changes across subgroups in analysis. The average health care costs were €1,966.4 and €13,914 per year for patients treated with conventional systemic therapy and biological agents, respectively. CONCLUSION A better knowledge of prescription therapeutic scheme and economic burden of PsA could stimulate the rational development of health programs aimed at potentiating services for its management.
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Affiliation(s)
- L Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - V Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - D Sangiorgi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - D Alessandrini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - S Buda
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - F Cantini
- Division of Rheumatology, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | | | - C Toma
- Bristol-Myers Squibb, Roma, Italy
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Jørgensen TS, Lykkegaard JJ, Hansen A, Schrøder HM, Stampe B, Sweeney AMT, Appel Esbensen B, Bech B, Christensen K, Friis-Mikkelsen E, Røgind H, Lundbak T, Taylor PC, Petersson IF, Wæhrens EE, Kjellberg J, Gudbergsen H, Kristensen LE. Protocol for evaluating and implementing a pragmatic value-based healthcare management model for patients with inflammatory arthritis: a Danish population-based regional cohort and qualitative implementation study. BMJ Open 2018; 8:e023915. [PMID: 30355794 PMCID: PMC6224730 DOI: 10.1136/bmjopen-2018-023915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The provision of healthcare for patients with inflammatory arthritis occurs in the context of somewhat conflicting targets, values and drivers. Therefore, there is a need for introducing 'value-based healthcare' defined as the value of patient relevant health outcomes in relation to costs. This term is a central part of tomorrow's healthcare sector, especially for rheumatic diseases, yet the transition is a huge challenge, as it will impact the development, delivery and assessment of healthcare. AIMS The aim of this study is to compare medical and patient evaluated impact of the traditional settlement and financing production (DAGS) controlled healthcare setting with a value-based and patient-centred adjunctive to standard care. METHODS AND ANALYSIS Patients with inflammatory arthritis receiving treatment in routine care at the outpatient clinics in the Capital Region of Denmark will prospectively and consecutively be enrolled in a Non-Intervention-Study framework providing a pragmatic value-based management model. A Danish reference cohort, used for comparison will be collected as part of routine clinical care. The enrolment period will be from 1 June 2018 until 31December 2023. Baseline and follow-up visits will be according to routine clinical care. Registry data will be obtained directly from patients and include personal, clinical and outcomes information. The study results will be reported in accordance with the STROBE statement. ETHICS AND DISSEMINATION The study has been notified to the Danish Data Protection Agency and granted authorisation for the period June 2018 to January 2025 (pending). Informed consent will be obtained from all patients before enrolment in the study. The study is approved by the ethics committee, Capital Region of Denmark (H-18013158). Results of the study will be disseminated through publication in international peer-reviewed journals.
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Affiliation(s)
| | - Jens Jørgen Lykkegaard
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Annette Hansen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Heidi Morsø Schrøder
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Betina Stampe
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Anne-Marie Tetsche Sweeney
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Bente Appel Esbensen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bianca Bech
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Katja Christensen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Ellen Friis-Mikkelsen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Henrik Røgind
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Tine Lundbak
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Department of Rheumatology, Copenhagen University Hospital, Glostrup, Denmark
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ingemar F Petersson
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund Sweden and Skåne University Hospital, Lund, Sweden
| | - Eva Ejlersen Wæhrens
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Jakob Kjellberg
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
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Kavanaugh A, Papp K, Gottlieb AB, de Jong EMGJ, Chakravarty SD, Kafka S, Langholff W, Farahi K, Srivastava B, Scher JU. Demography, baseline disease characteristics, and treatment history of psoriasis patients with self-reported psoriatic arthritis enrolled in the PSOLAR registry. BMC Rheumatol 2018; 2:29. [PMID: 30886979 PMCID: PMC6390609 DOI: 10.1186/s41927-018-0034-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background To evaluate demographics, family history, and previous medication use at enrollment in a subset of psoriasis patients with self-reported psoriatic arthritis (PsA) enrolled in Psoriasis Longitudinal Assessment and Registry (PSOLAR). Methods PSOLAR is an international, prospective, longitudinal, disease-based registry that collects data in patients receiving, or are eligible to receive, systemic or biologic treatments for psoriasis. Baseline demographic, disease characteristics, medical history, and prior medication use at enrollment were evaluated in PSOLAR psoriasis patients self-reporting PsA (n = 4315); a subset of which had their diagnosis of PsA established by a healthcare provider (HCP; n = 1719); patients with psoriasis only (n = 7775); and the overall PSOLAR population (n = 12,090). Results At enrollment, demographic characteristics were distinct between psoriasis patients self-reporting PsA and psoriasis only patients. Of the patients with psoriasis self-reporting PsA, 44.4% had cardiovascular disease (CVD), 26.3% had psychiatric illness, and 3.2% had inflammatory bowel disease (IBD), with each more prevalent than among patients with psoriasis only (p < 0.001). Overall, 17.5% of psoriasis patients self-reporting PsA had a family history of PsA, 29.8% had used systemic steroids, 39.5% had used nonsteroidal anti-inflammatory drugs, and 83.5% had used biologics. Conclusions Demographics, family history, and previous medication use were generally comparable between “PsA established by a HCP” patients and psoriasis patients self-reporting PsA in the PSOLAR registry, but there were statistical differences compared with the psoriasis only group regarding the prevalence of certain comorbidities (CVD, psychiatric illness, and IBD). These analyses provide important data regarding characteristics of psoriasis patients with self-reported PsA in PSOLAR. Trial registration NCT00508547. Electronic supplementary material The online version of this article (10.1186/s41927-018-0034-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arthur Kavanaugh
- 1Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, San Diego, CA USA
| | - Kim Papp
- 2K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON Canada
| | - Alice B Gottlieb
- 3New York Medical College, Metropolitan Hospital, New York, NY USA
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, and Radboud University, Nijmegen, The Netherlands
| | - Soumya D Chakravarty
- 5Janssen Scientific Affairs, LLC, Horsham, PA USA.,6Drexel University College of Medicine, Philadelphia, PA USA
| | - Shelly Kafka
- 5Janssen Scientific Affairs, LLC, Horsham, PA USA
| | | | | | | | - Jose U Scher
- 8Division of Rheumatology, New York University School of Medicine and Hospital for Joint Diseases, 301 East 17th Street, Room 1608, New York, NY 10003 USA
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Skov L, Thomsen SF, Kristensen LE, Dodge R, Hedegaard MS, Kjellberg J. Cause-specific mortality in patients with psoriasis and psoriatic arthritis. Br J Dermatol 2018; 180:100-107. [PMID: 29947129 DOI: 10.1111/bjd.16919] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are limited data regarding causes of mortality in patients with psoriasis or psoriatic arthritis (PsA). OBJECTIVES This retrospective cohort study evaluated the risk and leading causes of mortality in patients with psoriasis or PsA. METHODS Individuals with a hospital-based diagnosis of PsA or psoriasis were identified using the Danish National Patient Registry. Matched control individuals were identified from the general population. The main outcome measures were risk of death and cause-specific mortality in patients with psoriasis or PsA. RESULTS Death rates per 1000 patient-years (with 95% confidence intervals) vs. controls were 22·3 (19·7-24·9) vs. 13·9 (11·8-16·0) for patients with psoriasis and 10·8 (8·9-12·8) vs. 11·6 (9·6-13·6) for patients with PsA. Survival, according to stratified hazard ratios (HRs), was significantly lower in patients with psoriasis than in controls (HR 1·74, P < 0·001), but not in patients with PsA (HR 1·06, P = 0·19). Significantly increased risk of death was observed in patients with psoriasis vs. controls due to a number of causes; the highest risks were observed for diseases of the digestive system; endocrine, nutritional and metabolic diseases; and certain infectious and parasitic diseases (HRs 3·61, 3·02 and 2·71, respectively). In patients with PsA, increased mortality was observed only for certain infectious and parasitic diseases (HR 2·80) and diseases of the respiratory system (HR 1·46). Patients with psoriasis died at a younger age than controls (mean age 71·0 vs. 74·5 years, P < 0·001). CONCLUSIONS Patients with severe psoriasis have increased mortality risk compared with matched controls, due to a number of causes. Evidence to support an increased risk for patients with PsA was less convincing.
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Affiliation(s)
- L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L E Kristensen
- Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
| | - R Dodge
- Novartis Healthcare, Copenhagen, Denmark
| | | | - J Kjellberg
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
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Affiliation(s)
- William Tillett
- Royal National Hospital for Rheumatic Diseases; and Department of Pharmacy and Pharmacology, University of Bath, Bath;
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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Hajiebrahimi M, Linder M, Hägg D, Berglind IA, McElligott S, Valgardsson VS, Villacorta R, Sundström A. Young patients with risk factors prevalent in the elderly - differences in comorbidity depending on severity of psoriasis: a nationwide cross-sectional study in Swedish health registers. Clin Epidemiol 2018; 10:705-715. [PMID: 29950900 PMCID: PMC6016015 DOI: 10.2147/clep.s164918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Association between psoriasis severity and cerebro- and cardiovascular comorbidities has rarely been investigated. Aim We aimed to investigate differences in cerebro- and cardiovascular comorbidities by psoriasis severity. Materials and methods Using Swedish nationwide health-care registers, new adult users of anti-psoriatic drugs (2007–2013) with a recorded diagnosis of psoriasis/psoriatic arthritis or a filled prescription for calcipotriol were included. Psoriasis severity was based on the type of anti-psoriatic treatment (topical/mild, non-biologic systemic/moderate-to-severe, and biologics/ severe). Age standardized prevalence rates of cerebro- and cardiovascular comorbidities and their risk factors were compared between the groups. Results We found that severe psoriasis patients (N=2147) were younger than moderate-to-severe (N=11,919) or mild (N=70,796) patients (median 44, 52, and 55 years). Prevalence of hypertension was 29.9%, 32.6%, and 36.5%, myocardial infarction was 2.5%, 2.3%, and 1.8%, and stroke was 2.4%, 2.2%, and 1.1% in mild, moderate-to-severe, and severe psoriasis patients, respectively. Diabetes prevalence was 7.6% in mild, 8.0% in moderate-to-severe, and 10.7% in severe psoriasis. Conclusion Myocardial infarction and stroke were less common in patients with severe psoriasis while, despite being younger, they had a higher prevalence of diabetes and hypertension.
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Affiliation(s)
- Mohammadhossein Hajiebrahimi
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Statistics and Epidemiology Unit, Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran
| | - Marie Linder
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David Hägg
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ina Anveden Berglind
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Anders Sundström
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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D'Angiolella LS, Cortesi PA, Lafranconi A, Micale M, Mangano S, Cesana G, Mantovani LG. Cost and Cost Effectiveness of Treatments for Psoriatic Arthritis: A Systematic Literature Review. Pharmacoeconomics 2018; 36:567-589. [PMID: 29441473 DOI: 10.1007/s40273-018-0618-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Psoriatic arthritis is a long-term inflammatory arthropathy occurring in a subgroup of patients with psoriasis. In addition to irreversible bone erosions, joint destruction, and skin manifestations, psoriatic arthritis is associated with numerous comorbid conditions. Over the last 5 years, new treatments emerged; the analysis and comparisons of their additional costs and the added benefits have become increasingly important to optimize the limited resources available. METHODS A systematic literature review covering PubMed, EMBASE, and the Cochrane Library was performed from May 2012 to October 2017 focusing on the most recent evidence of costs, benefits, and burden of psoriatic arthritis and its treatments. All economic evaluations assessing the burden of patients with psoriatic arthritis and written in English were eligible for inclusion. We also performed an assessment of the quality of the studies. RESULTS Of the 1652 references found in the literature search, nine cost-effectiveness analyses and 12 cost-of-illness studies were included in the current review. Patients with psoriatic arthritis incur substantially higher direct and indirect costs, as compared with patients with psoriasis without arthritis or patients with other inflammatory diseases. The cost of treatment with biologic therapies is the major predictor of the total cost. However, individuals with psoriatic arthritis are also affected by substantial productivity losses and indirect costs. Biologic therapies are generally cost effective vs. conventional therapies (e.g., synthetic drugs) for treating psoriatic arthritis. CONCLUSIONS Psoriatic arthritis is associated with a significant economic burden and biologic therapies contribute significantly to these costs. Biologic therapies are more effective than disease-modifying anti-rheumatic drugs for the symptoms and signs of psoriatic arthritis and for improving quality of life and inhibiting structural radiological damage. Therefore, biologic therapies are cost effective compared with conventional therapies: the increased direct cost associated with biologic drugs is offset by the significant improvement in the efficacy of treatments and in patient management of psoriatic arthritis.
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Affiliation(s)
- Lucia Sara D'Angiolella
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Alessandra Lafranconi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Mariangela Micale
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Sveva Mangano
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy.
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McCormick N, Marra CA, Sadatsafavi M, Aviña-Zubieta JA. Incremental direct medical costs of systemic lupus erythematosus patients in the years preceding diagnosis: A general population-based study. Lupus 2018; 27:1247-1258. [PMID: 29665755 DOI: 10.1177/0961203318768882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We estimated the incremental (extra) direct medical costs of a population-based cohort of newly diagnosed systemic lupus erythematosus (SLE) for five years before and after diagnosis, and the impact of sex and socioeconomic status (SES) on pre-index costs for SLE. Methods We identified all adults newly diagnosed with SLE over 2001-2010 in British Columbia, Canada, and obtained a sample of non-SLE individuals from the general population, matched on sex, age, and calendar-year of study entry. We captured costs for all outpatient encounters, hospitalisations, and dispensed medications each year. Using generalised linear models, we estimated incremental costs of SLE each year before/after diagnosis (difference in costs between SLE and non-SLE, controlling for covariates). Similar models were used to examine the impact of sex and SES on costs within SLE. Results We included 3632 newly diagnosed SLE (86% female, mean age 49.6 ± 15.9) and 18,060 non-SLE individuals. Over the five years leading up to diagnosis, per-person healthcare costs for SLE patients increased year-over-year by 35%, on average, with the biggest increases in the final two years by 39% and 97%, respectively. Per-person all-cause medical costs for SLE the year after diagnosis (Year + 1) averaged C$12,019 (2013 Canadian) with 58% from hospitalisations, 24% outpatient, and 18% from prescription medications; Year + 1 costs for non-SLE averaged C$2412. Following adjustment for age, sex, urban/rural residence, socioeconomic status, and prior year's comorbidity score, SLE was associated with significantly greater hospitalisation, outpatient, and medication costs than non-SLE in each year of study. Altogether, adjusted incremental costs of SLE rose from C$1131 per person in Year -5 (fifth year before diagnosis) to C$2015 (Year -2), C$3473 (Year -1) and C$6474 (Year + 1). In Years -2, -1 and +1, SLE patients in the lowest SES group had significantly greater costs than the highest SES. Unlike the non-SLE cohort, male patients with SLE had higher costs than females. Annual incremental costs of SLE males (vs. SLE females) rose from C$540 per person in Year -2, to C$1385 in Year -1, and C$2288 in Year + 1. Conclusion Even years before diagnosis, SLE patients incur significantly elevated direct medical costs compared with the age- and sex-matched general population, for hospitalisations, outpatient care, and medications.
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Affiliation(s)
- N McCormick
- 1 Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,2 Arthritis Research Canada, Richmond, BC, Canada
| | - C A Marra
- 1 Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.,2 Arthritis Research Canada, Richmond, BC, Canada.,3 School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - M Sadatsafavi
- 1 Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - J A Aviña-Zubieta
- 2 Arthritis Research Canada, Richmond, BC, Canada.,4 Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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