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Berthelsen DB, Nielsen SM, Rasmussen MU, Voshaar M, Richards P, Bartlett SJ, Hazlewood GS, Shea BJ, Tugwell P, Ellingsen T, Jørgensen TS, Kristensen S, Simon LS, Christensen R, Flurey CA. "I couldn't carry on taking a drug like that": A qualitative study of patient perspectives on side effects from rheumatology drugs. Rheumatology (Oxford) 2024:keae223. [PMID: 38613847 DOI: 10.1093/rheumatology/keae223] [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: 10/31/2023] [Revised: 02/25/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES There is growing interest in collecting outcome information directly from patients in clinical trials. This study evaluates what patients with rheumatic and musculoskeletal diseases (RMDs) consider important to know about symptomatic side effects they may experience from a new prescription drug. METHODS Patients with inflammatory arthritis, who had one or more prescribed drugs for their disease for at least 12 months, participated in focus groups and individual interviews. Discussions were analysed using reflexive thematic analysis. RESULTS We conducted seven focus groups with 34 participants across three continents. We found four overarching and two underpinning themes. The 'impact on life' was connected to participants 'daily life', 'family life', 'work life', and 'social life'. In 'psychological and physical aspects' participants described 'limitation to physical function', 'emotional dysregulation' and 'an overall mental state'. Extra tests, hospital visits and payment for medication were considered a 'time, energy and financial burden' of side effects. Participants explained important measurement issues to be 'severity', 'frequency', and 'duration'. Underpinning these issues, participants evaluated the 'benefit-harm-balance' which includes 'the cumulative burden' of having several side effects and the persistence of side effects over time. CONCLUSIONS In treatment for RMDs, there seems to be an urgent need for feasible measures of patient-reported bother (impact on life and cumulative burden) from side effects and the benefit-harm-balance. These findings contribute new evidence in support of a target domain-an outcome that represents the patient voice evaluating the symptomatic treatment-related side effects for people with RMDs enrolled in clinical trials.
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Affiliation(s)
- Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Marianne U Rasmussen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marieke Voshaar
- Department of Pharmacy, Sint Maartenskliniek, Department of Pharmacy, Radboud UMC, Nijmegen, The Netherlands
| | - Pamela Richards
- Department of Rheumatology, University of Bristol, Bristol, United Kingdom
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada
- Research Institute, McGill University Health Centre, Montreal, Canada
- Arthritis Research, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Arthritis Research Canada
| | - Beverly J Shea
- School of Epidemiology and Public Health, University of Ottawa, Ottawa ON, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Tanja S Jørgensen
- Value-Based Outcomes Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, and Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | | | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- Cochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), Department of Clinical Research, University of Southern Denmark, Denmark
| | - Caroline A Flurey
- School of Social Sciences, University of the West of England, Bristol, United Kingdom
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2
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Stisen ZR, Nielsen SM, Ditlev SB, Skougaard M, Egeberg A, Mogensen M, Jørgensen TS, Dreyer L, Christensen R, Kristensen LE. Treatment-related changes in serum neutrophil gelatinase-associated lipocalin (NGAL) in psoriatic arthritis: results from the PIPA cohort study. Scand J Rheumatol 2024; 53:21-28. [PMID: 37339383 DOI: 10.1080/03009742.2023.2216046] [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] [Received: 03/01/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Obesity and psoriatic arthritis (PsA) have a complicated relationship. While weight alone does not cause PsA, it is suspected to cause worse symptoms. Neutrophil gelatinase-associated lipocalin (NGAL) is secreted through various cell types. Our objective was to assess the changes and trajectories in serum NGAL and clinical outcomes in patients with PsA during 12 months of anti-inflammatory treatment. METHOD This exploratory prospective cohort study enrolled PsA patients initiating conventional synthetic or biological disease-modifying anti-rheumatic drugs (csDMARDs/bDMARDs). Clinical, biomarker, and patient-reported outcome measures were retrieved at baseline, and 4 and 12 months. Control groups at baseline were psoriasis (PsO) patients and apparently healthy controls. The serum NGAL concentration was quantified by a high-performance singleplex immunoassay. RESULTS In total, 117 PsA patients started a csDMARD or bDMARD, and were compared indirectly at baseline with a cross-sectional sample of 20 PsO patients and 20 healthy controls. The trajectory in NGAL related to anti-inflammatory treatment for all included PsA patients showed an overall change of -11% from baseline to 12 months. Trajectories in NGAL for patients with PsA, divided into treatment groups, showed no clear trend in clinically significant decrease or increase following anti-inflammatory treatment. NGAL concentrations in the PsA group at baseline corresponded to the levels in the control groups. No correlation was found between changes in NGAL and changes in PsA outcomes. CONCLUSION Based on these results, serum NGAL does not add any value as a biomarker in patients with peripheral PsA, either for disease activity or for monitoring.
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Affiliation(s)
- Z R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S M Nielsen
- 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, Denmark
| | - S B Ditlev
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - M Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - A Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - R 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, Denmark
| | - L E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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3
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Hansen RL, Jørgensen TS, Egeberg A, Rosenø NAL, Skougaard M, Stisen ZR, Dreyer L, Kristensen LE. Adherence to therapy of ixekizumab and secukinumab in psoriatic arthritis patients using first- or second-line IL-17A inhibitor treatment: A Danish population-based cohort study. Rheumatology (Oxford) 2023:kead434. [PMID: 37647648 DOI: 10.1093/rheumatology/kead434] [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: 04/25/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To assess the effectiveness and tolerability of first- and second-line interleukin (IL)-17A inhibitor treatment in patients with psoriatic arthritis (PsA) from 2014 to 2021, using data from the Danish Rheumatology Registry (DANBIO) by investigating adherence to therapy. METHOD PsA patients recorded in DANBIO who received a first- or second-line IL-17A inhibitor treatment were included in this study. All patients included had previously received ≥1 TNFi treatment. Baseline characteristics were analyzed in subgroups: first-line IL-17A inhibitor treatment and second-line IL-17A inhibitor treatment. adherence to therapy of first- or second-line IL-17A inhibitor treatments were reported as Kaplan-Meier plots. RESULTS 534 patients were included in the study; first-line switchers: 534 (secukinumab: 510, ixekizumab: 24), second-line switchers: 102 (secukinumab: 35, ixekizumab: 67). Baseline characteristics showed a similar Health Assessment questionnaire (HAQ) and Visual Analogue Scale (VAS) pain. VAS global, Disease Assessment Score-28CRP and previous number of bDMARD treatments are similar with a greater value for second-line switchers. First-line ixekizumab treated patients present a younger age, greater percentage of females, a lower disease duration and a lower CRP value. Concomitant MTX use was greater for the first-line secukinumab treated patients. First- and second-line switchers had a similar adherence to therapy. Second-line secukinumab and second-line ixekizumab switchers showed a similar adherence to treatment. CONCLUSION PsA patients receiving first- or second-line IL-17A inhibitors showed homogeneous baseline characteristics and similar adherence to therapy. Treatment failure of the first IL-17A inhibitor treatment should not preclude a second-line IL-17A inhibitor treatment.
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Affiliation(s)
- Rebekka L Hansen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Tanja S Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nana A L Rosenø
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Marie Skougaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Rheumatology, Center of Rheumatic Research Aalborg (CERRA), Aalborg University hospital, Aalborg University, Denmark
| | - Zara R Stisen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Center of Rheumatic Research Aalborg (CERRA), Aalborg University hospital, Aalborg University, Denmark
- The Danish Rheumatologic Database (DANBIO), Denmark
| | - Lars-Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
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4
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Petersen MB, Hansen RL, Egeberg A, Jørgensen TS, Merola JF, Coates LC, Kristensen LE. The impact of comorbidities on interleukin-17 inhibitor therapy in psoriatic arthritis: a Danish population-based cohort study. Rheumatol Adv Pract 2023; 7:rkad035. [PMID: 37091296 PMCID: PMC10118995 DOI: 10.1093/rap/rkad035] [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: 11/07/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
Abstract
Objective
To investigate the influence of comorbidities on treatment response, disease activity, and persistence with first-line interleukin-17 inhibitor (IL-17i) treatment in patients with psoriatic arthritis (PsA).
Methods
Patients were divided into three groups depending on the presence and/or severity of comorbidities, using the Charlson Comorbidity Index (CCI). Groups were
CCI = 0
no comorbidities,
CCI = 1
one comorbidity, and
CCI ≥ 2
2 or more comorbidities or 1 or more severe comorbidities. Outcomes in the groups were compared for treatment persistence, treatment response and disease activity.
Results
A higher CCI score was associated to an elevation in baseline CRP, swollen joint count and frequency of depression and/or anxiety. Median drug persistence in the groups were: CCI = 0: 1.8 years, CCI = 1: 1.9 years and CCI ≥ 2: 1.5 years, but was not statistically significant to CCI score. There were no significant differences in clinical response rates between the groups.
Conclusion
The presence of comorbidities was associated with increased baseline disease activity and frequency of depression and/or anxiety, but was not associated with shorter treatment persistence or lower clinical response rates, in a cohort of 155 Danish patients with PsA treated with first-line IL-17i.
Lay summary
What does this mean for patients?
Choosing the right biological treatment for people with psoriatic arthritis (PsA) can be problematic. It is not unusual for these patients to shuffle between multiple treatments before a satisfactory treatment has been found. The first-line biological treatment for people with PsA is usually a TNF inhibitor. However, TNF inhibitors have been shown to be less effective in those with comorbidities (i.e. people with two or more simultaneous medical conditions), compared with those without. People with comorbidities are also less likely to continue to take the TNF inhibitor for the prescribed period of time. Since more than 50% of people with PsA have one or several comorbidities, we wondered if IL-17 inhibitors (another type of biological drug) act in this same manner. We studied 155 people with PsA treated with IL-17 inhibitors and found that, unlike TNF inhibitors, IL-17 inhibitors were not less effective in people with comorbidities. Likewise, people with comorbdities were not more likely to discontinue treatment with IL-17 inhibitors than those without comorbidities. Because we investigated a small group of patients, these results must be reproduced in larger groups. However, we think that these results are novel and could be an important clinical tool for quickly choosing the best biological treatment for PsA patients with comorbidities. This would benefit patients and also minimize ineffective courses of treatment, as well as societal costs.
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Affiliation(s)
- Magnus B Petersen
- The Parker institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg , Denmark
| | - Rebekka L Hansen
- The Parker institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg , Denmark
| | - Alexander Egeberg
- Bispebjerg Hospital Department of Dermatology, , Copenhagen, Denmark
| | - Tanja S Jørgensen
- The Parker institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg , Denmark
- DANBIO Registry and Rigshospitalet , Glostrup, Denmark
| | - Joseph Frank Merola
- Harvard Medical School Department of Medicine, Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, , Boston, MA, USA
| | - Laura C Coates
- University of Oxford Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, , Oxford, UK
| | - Lars Erik Kristensen
- The Parker institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg , Denmark
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5
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Skougaard M, Stisen ZR, Jørgensen TS, Egeberg A, Hansen RL, Perez-Chada LM, Mogensen M, Merola JF, Gerwien JG, Kristensen LE. Increased prevalence of sleep disturbance in psoriatic arthritis is associated with inflammatory and non-inflammatory measures. Scand J Rheumatol 2022; 52:259-267. [PMID: 35302402 DOI: 10.1080/03009742.2022.2044116] [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: 10/18/2022]
Abstract
OBJECTIVES To examine the prevalence of sleep disturbances, quantified by the Pittsburgh Sleep Quality Index (PSQI), in patients with psoriatic arthritis (PsA), psoriasis (PsO) and healthy controls (HCs), explore associations between PSQI and clinical and patient-reported outcomes, and evaluate the effect of treatment on PSQI. METHOD Patients were included from the Parker Institute's PsA patient cohort to evaluate the prevalence of sleep disturbances. Univariate and multivariate regression analyses were used to explore associations between sleep disturbance and outcome measures. Treatment effect in PsA patients was assessed with a mixed-effect model for repeated measures. RESULTS In total, 109 PsA patients, 20 PsO patients, and 20 HCs were included. Sleep disturbances were reported by 66.1% of PsA patients, 45.0% of PsO patients, and 15.0% of HCs. Univariate regression analyses revealed statistically significant associations (p < 0.001) between PSQI and Disease Activity Score (DAS28CRP), tender points, visual analogue scale (VAS) patient global and pain, Psoriatic Arthritis Impact of Disease fatigue, Health Assessment Questionnaire (HAQ), and painDETECT score. Multivariate regression analysis demonstrated VAS patient global, VAS pain, and tender points as being independently associated with PSQI. The mixed-effect model revealed no effect of treatment. CONCLUSION More PsA patients than PsO patients and HCs reported sleep disturbances. Sleep disturbances were associated with inflammatory and non-inflammatory measures possibly explaining the limited effect of treatment. This demonstrates the need for interdisciplinary approaches to improve the management of sleep disturbance in PsA.Trial registration: ClinicalTrials.gov (NCT02572700).
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Affiliation(s)
- M Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Z R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - T S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - A Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - R L Hansen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - L M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - L E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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6
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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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7
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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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8
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Pouls BPH, Kristensen LE, Petersson M, van den Bemt BJF, Ballerini L, Bruggraber R, Karlen H, Mountian I, van Bracht E, Wiegratz S, Jørgensen TS. A pilot study examining patient preference and satisfaction for ava®, a reusable electronic injection device to administer certolizumab pegol. Expert Opin Drug Deliv 2020; 17:705-711. [PMID: 32154740 DOI: 10.1080/17425247.2020.1736552] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Anti-tumor necrosis factor (anti-TNF) adherence is suboptimal. ava®, a reusable electromechanical self-injection device (e-Device) developed for certolizumab pegol (CZP) administration, aims to overcome some barriers to increase adherence. This study evaluates patient experience of the e-Device and its training materials and determines patient device preference.Methods: CZP-treated patients were recruited from the Netherlands, Denmark and Sweden. Patients completed a pre-injection Assessment of Self-Injection (ASI) questionnaire investigating self-injection perception. After training, patients administered 3 consecutive self-injections using the e-Device, patient experience of each was assessed using the post-injection ASI. An additional questionnaire evaluated training materials. After Injection 3, patients indicated their preference: the e-Device or their previous device.Results: 59 patients participated; most rated the e-Device highly for satisfaction, self-confidence and ease of use. The (negative) feelings and pain and skin reactions domains had low ratings. Post-injection ASI domain scores were similar following each of the 3 e-Device injections. Training materials were rated highly (video: 8.4/10; step-by-step guide: 8.4/10). 57.1% (32/56) patients preferred the e-Device over their previous self-injection device.Conclusions: Patients were satisfied with the e-Device and most preferred it over other self-injection devices. By improving patient experience, the e-Device may help increase medication adherence.
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Affiliation(s)
- Bart P H Pouls
- Sint Maartenskliniek, Nijmegen, Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars E Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Marianne Petersson
- Department of Molecular and Clinical Medicine, Linköping University, Linköping, Sweden
| | - B J F van den Bemt
- Sint Maartenskliniek, Nijmegen, Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | | | - Tanja S Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
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9
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Jørgensen TS, Skougaard M, Taylor PC, Asmussen HC, Lee A, Klokker L, Svejstrup L, Mountian I, Gudbergsen H, Kristensen LE. The Parker Model: Applying a Qualitative Three-Step Approach to Optimally Utilize Input from Stakeholders When Introducing New Device Technologies in the Management of Chronic Rheumatic Diseases. Patient 2019; 11:515-526. [PMID: 29948962 PMCID: PMC6132441 DOI: 10.1007/s40271-018-0306-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objective Qualitative methods such as semi-structured interviews and focus-groups are used to evaluate the applicability and relevance of device technologies in clinical practice, but when used alone, often lack generalizability. This study aimed to assess the face validity and feasibility of using a composite, three-step qualitative method (the Parker Model), to inform the development and implementation of ava®, an electromechanical device (e-Device) for subcutaneous self-administration of the biologic, certolizumab pegol (CZP), used to treat rheumatic diseases. Methods The Parker Model combines concept mapping (CM), participatory design (PD), and stakeholder evaluation (SE). CM, a structured group process, was used to identify patients’ opinions and concerns regarding the e-Device. Patients used this information in iterative PD sessions to create personal e-Device prototypes in cooperation with a designer and a healthcare professional. SE was performed based on semi-structured group and individual interviews with patients and disease-management stakeholders. Results The study recruited 14 patients, two doctors, two nurses, one medical secretary, and four other public servants. Three CM workshops revealed four key considerations: technical usability, physical design, concerns, and enthusiasm. Four personalized prototypes were developed during PD sessions. SE confirmed that the identified considerations were pivotal for the implementation and adaptation of the e-Device. Conclusions This study is the first to apply a composite, qualitative research model when introducing an e-Device for the treatment and management of rheumatic disease. Results show that input from patients and other stakeholders using the Parker Model can add value to the development and implementation of an e-Device. Electronic supplementary material The online version of this article (10.1007/s40271-018-0306-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tanja S Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Marie Skougaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal, Sciences, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Hans C Asmussen
- NATiON, 110 A, Refshalevej, Room 205, 1432, Copenhagen, Denmark
| | - Anne Lee
- University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Louise Svejstrup
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg, Frederiksberg, Denmark
| | - Irina Mountian
- UCB Pharma, Allée de la Recherche, 60, 1070, Brussels, Belgium
| | - 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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10
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Tarp S, Jørgensen TS, Furst DE, Dossing A, Taylor PC, Choy EH, Suarez-Almazor ME, Lyddiatt A, Kristensen LE, Bliddal H, Christensen R. Added value of combining methotrexate with a biological agent compared to biological monotherapy in rheumatoid arthritis patients: A systematic review and meta-analysis of randomised trials. Semin Arthritis Rheum 2018; 48:958-966. [PMID: 30396592 DOI: 10.1016/j.semarthrit.2018.10.002] [Citation(s) in RCA: 7] [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: 02/17/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of methotrexate (MTX) in combination with an approved biological agent compared to biological monotherapy, in the management of patients with rheumatoid arthritis (RA). METHODS MEDLINE, EMBASE, CENTRAL and other sources were searched for randomised trials evaluating a biological agent plus MTX versus the same biological agent in monotherapy. Co-primary outcomes were ACR50 and the number of patients who discontinued due to adverse events (AEs). Random-effects models were applied for meta-analyses with risk ratio and 95% confidence intervals and the GRADE approach was used to assess confidence in the estimates. RESULTS The analysis comprised 16 trials (4965 patients), including all biological agents approved for RA except anakinra and certolizumab. The overall likelihood of responding to therapy (i.e. ACR50) after 6 months was 32% better when MTX was given concomitantly with biological agents (1.32 [1.20-1.45]; P < 0.001) corresponding to 11 more out of 100 patients (7-16 more); Moderate Quality Evidence. Discontinuing due to AEs from concomitant use of MTX was potentially 20% increased (1.21 [0.97-1.50]; P = 0.09) compared to biological monotherapy corresponding to 1 more out of 100 patients (0-3 more); Moderate Quality Evidence. CONCLUSIONS Randomised trials provide Moderate Quality Evidence for a favourable benefit-harm balance supporting concomitant use of MTX rather than monotherapy when prescribing a biological agent in patients with RA although in absolute terms only 7-16 more out of 100 patients will achieve an ACR50 response after 6 months of this combination therapy.
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Affiliation(s)
- Simon Tarp
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark.
| | - Tanja S Jørgensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Daniel E Furst
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Anna Dossing
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Ernest H Choy
- Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK; CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maria E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne Lyddiatt
- Musculoskeletal Group, Cochrane Collaboration, Ottawa, ON K1H 8L6, Canada
| | - Lars E Kristensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Copenhagen, Denmark
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Glintborg B, Lindström U, Aaltonen K, Kristianslund EK, Gudbjornsson B, Chatzidionysiou K, Askling J, Nordström D, Hetland ML, Di Giuseppe D, Dreyer L, Kristensen LE, Jørgensen TS, Eklund K, Grondal G, Ernestam S, Joensuu J, Törmänen MRK, Skydsgaard H, Hagfors J, Kvien TK, Lie E, Fagerli K, Geirsson AJ, Jonsson H, Provan SA, Krogh NS, Jacobsson LTH. Biological treatment in ankylosing spondylitis in the Nordic countries during 2010–2016: a collaboration between five biological registries. Scand J Rheumatol 2018; 47:465-474. [DOI: 10.1080/03009742.2018.1444199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Aaltonen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | - EK Kristianslund
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - B Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - K Chatzidionysiou
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - D Nordström
- Department of Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - ML Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - D Di Giuseppe
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - L Dreyer
- Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - LE Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - TS Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - K Eklund
- Department of Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - G Grondal
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - S Ernestam
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - J Joensuu
- Faculty of Pharmacy, University of Helsinki, Helsinki,Finland
| | - MRK Törmänen
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - H Skydsgaard
- The Danish Rheumatism Association, Copenhagen, Denmark
| | - J Hagfors
- Norwegian Rheumatism Association, Oslo, Norway
| | - TK Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Lie
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - K Fagerli
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - AJ Geirsson
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - H Jonsson
- Department of Rheumatology, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - SA Provan
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Ballegaard C, Jørgensen TS, Skougaard M, Strand V, Mease PJ, Kristensen LE, Dreyer L, Gottlieb A, de Wit M, Christensen R, Tarp S. Trial Characteristics as Contextual Factors When Evaluating Targeted Therapies in Patients With Psoriatic Disease: A Meta-Epidemiologic Study. Arthritis Care Res (Hoboken) 2017; 70:1206-1217. [PMID: 29073353 DOI: 10.1002/acr.23455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the importance of trial characteristics as contextual factors when evaluating the treatment effect of targeted therapies for patients with psoriatic disease. METHODS We identified randomized controlled trials (RCTs) evaluating targeted therapies approved for psoriatic arthritis (PsA) and psoriasis (8 biologics and apremilast). The effect of targeted therapies was analyzed in the 2 psoriatic conditions combined by using drug retention as a common outcome, and separately by using the American College of Rheumatology 20% improvement criteria (ACR20) for PsA and the Psoriasis Area Severity Index 75% improvement score (PASI75) for psoriasis. We explored potential effect modification of trial characteristics in stratified and meta-regression analyses. Odds ratios (ORs) were calculated and compared among the trial eligibility criteria via the ratio of ORs. RESULTS Forty-eight PsA and psoriasis trials (51 comparisons; 17,737 patients) were eligible. Overall retention was OR 2.16 (95% confidence interval [95% CI] 1.70-2.75) with higher odds for PsA trials compared with psoriasis trials (ratio of ORs 2.55 [95% CI 1.64-3.97]). The eligibility criteria "targeted therapy history," "minimum required disease duration," "required negative rheumatoid factor," and "required Classification Criteria for Psoriatic Arthritis criteria" were of importance for achieving ACR20 in PsA. The eligibility criterion "minimum required disease duration" was of importance for achieving PASI75 in psoriasis. A total of 7 PsA trials had rescue before time-point-of-retention reporting (adaptive trials). CONCLUSION From this exploratory meta-epidemiologic study, we now have evidence from RCTs to support the notion that patients with PsA are more likely to adhere to targeted therapies compared to patients with psoriasis. Furthermore, we identified a few contextual factors of importance in regard to achieving ACR20 in PsA trials and PASI75 in psoriasis trials.
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Affiliation(s)
- Christine Ballegaard
- Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, and Gentofte Hospital, Copenhagen, Denmark
| | - Tanja S Jørgensen
- Parker Institute, Copenhagen University Hospital, and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marie Skougaard
- Parker Institute, Copenhagen University Hospital, and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Vibeke Strand
- Stanford University School of Medicine, Palo Alto, California
| | - Philip J Mease
- Seattle Rheumatology Associates, Swedish Medical Centre, and University of Washington, Seattle
| | - Lars E Kristensen
- Parker Institute, Copenhagen University Hospital, and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Dreyer
- Gentofte Hospital and Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Maarten de Wit
- VU University Medical Centre, Amsterdam, the Netherlands
| | - Robin Christensen
- Parker Institute, Copenhagen University Hospital, and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Simon Tarp
- Parker Institute, Copenhagen University Hospital, and Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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13
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Kristensen LE, Jørgensen TS, Christensen R, Gudbergsen H, Dreyer L, Ballegaard C, Jacobsson LTH, Strand V, Mease PJ, Kjellberg J. Societal costs and patients' experience of health inequities before and after diagnosis of psoriatic arthritis: a Danish cohort study. Ann Rheum Dis 2017; 76:1495-1501. [PMID: 28137915 DOI: 10.1136/annrheumdis-2016-210579] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 09/23/2016] [Revised: 12/13/2016] [Accepted: 01/08/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To comprehensively study the comorbidities, healthcare and public transfer (allowance) costs in patients with psoriatic arthritis (PsA) before and after diagnosis. METHODS Nationwide cohort study, using data from Danish registries from January 1998 through December 2014. A total of 10 525 patients with PsA and 20 777 matched general population comparator (GPC) subjects were included. Societal costs, employment status and occurrence of comorbidities in patients with PsA both before and after diagnosis were compared with GPC subjects. RESULTS At baseline, patients with PsA had significantly more comorbidities, including cardiovascular disease (OR 1.70 95% CI 1.55 to 1.86), respiratory diseases (OR 1.73 95% CI 1.54 to 1.96) and infectious diseases (OR 2.03 95% CI 1.69 to 2.42) compared with GPC subjects. At all time points, patients with PsA had higher total healthcare and public transfer costs; they also had lower income (p<0.001) and incurred a net average increased societal cost of €10 641 per patient-year compared with GPC subjects following diagnosis. The relative risk (RR) for being on disability pension 5 years prior to PsA diagnosis was 1.36 (95% CI 1.24 to 1.49) compared with GPC subjects. The RR increased to 1.60 (95% CI 1.49 to 1.72) at the time of diagnosis and was 2.69 (95% CI 2.40 to 3.02) 10 years after diagnosis, where 21.8% of the patients with PsA received disability pension. CONCLUSIONS Our findings are suggestive of health inequity for patients with PsA and call for individual preventive measures and societal action.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark
| | - Tanja S Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark
| | - Lene Dreyer
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.,Gentofte Hospital, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Hellerup, Denmark
| | - Christine Ballegaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Jakob Kjellberg
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
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