Real-World Outcomes Associated With Methotrexate, Sulfasalazine, and Hydroxychloroquine Triple Therapy Versus Tumor Necrosis Factor Inhibitor/Methotrexate Combination Therapy in Patients With Rheumatoid Arthritis.
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal
/ adverse effects
Antirheumatic Agents
/ adverse effects
Arthritis, Rheumatoid
/ diagnosis
Biological Products
/ adverse effects
Drug Therapy, Combination
Female
Humans
Hydroxychloroquine
/ adverse effects
Male
Methotrexate
/ adverse effects
Middle Aged
Registries
Sulfasalazine
/ adverse effects
Time Factors
Treatment Outcome
Tumor Necrosis Factor Inhibitors
/ adverse effects
United States
Journal
Arthritis care & research
ISSN: 2151-4658
Titre abrégé: Arthritis Care Res (Hoboken)
Pays: United States
ID NLM: 101518086
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
14
08
2019
accepted:
28
04
2020
pubmed:
7
5
2020
medline:
14
9
2021
entrez:
7
5
2020
Statut:
ppublish
Résumé
Though randomized controlled trials have demonstrated relatively comparable clinical outcomes with triple therapy (methotrexate [MTX], sulfasalazine [SSZ], and hydroxychloroquine [HCQ]) compared to combination therapy (tumor necrosis factor inhibitor [TNFi] and MTX), real-world experiences comparing these strategies have not been well studied. We evaluated the clinical effectiveness and effects of medication discontinuation of triple therapy with MTX/SSZ/HCQ versus combination therapy with TNFi/MTX in rheumatoid arthritis (RA) patients enrolled in the Corrona RA Drug Safety & Effectiveness Registry. Propensity score matching was used to match patients up to a ratio of 1:3 to adjust for imbalances between treatment groups, with stratification performed according to biologics-naive or biologics-exposed status of study participants. Patients eligible for analysis in this study included biologics-naive RA patients (3,926 who received combination therapy with TNFi/MTX and 262 who received triple therapy with MTX/SSZ/HCQ) and biologics-exposed RA patients (3,365 who received combination therapy with TNFi/MTX and 130 patients who received triple therapy with MTX/SSZ/HCQ). Before propensity score matching, numerous factors were imbalanced between the treatment groups, with triple therapy patients generally being older, having a longer disease duration of RA and lower RA disease activity, and more likely having a history of malignancy and other comorbidities. After matching, almost all (93-98%) triple therapy patients could be matched to TNFi/MTX therapy patients, and cohort characteristics were generally well balanced. Discontinuation of medication was greater in triple therapy patients referent to TNFi/MTX therapy patients (adjusted hazard ratio [HR] of 2.17 [95% confidence interval 1.63-2.88] in the biologics-naive group; adjusted HR of 1.51 [95% confidence interval 1.06-2.15] in the biologics-exposed group). At 6 months, the proportion of biologics-naive patients attaining low disease activity was significantly greater in the TNFi/MTX treatment group (49.2% in TNFi/MTX therapy patients versus 33.3% in triple therapy patients), as was the mean change in Clinical Disease Activity Index scores (-9.3 units versus -5.5 [95% confidence interval -1.5, -6.1]). Corresponding results in the biologics-exposed patients numerically favored TNFi/MTX therapy compared to triple therapy but did not reach statistical significance. Few patients receive triple therapy with MTX/SSZ/HCQ in the US. In the present study, drug persistence and clinical effectiveness outcomes were less favorable in triple therapy patients compared to TNFi/MTX therapy patients.
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Antirheumatic Agents
0
Biological Products
0
Tumor Necrosis Factor Inhibitors
0
Sulfasalazine
3XC8GUZ6CB
Hydroxychloroquine
4QWG6N8QKH
Methotrexate
YL5FZ2Y5U1
Types de publication
Comparative Study
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1114-1124Subventions
Organisme : AHRQ HHS
ID : R01 HS018517
Pays : United States
Organisme : NIAMS NIH HHS
ID : P30 AR072583
Pays : United States
Informations de copyright
© 2020, American College of Rheumatology.
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