title: A European chart review study on early rheumatoid arthritis treatment patterns, clinical outcomes, and healthcare utilization.
abstract: This retrospective medical chart review aimed to provide a current, real-world overview of biologic usage in patients with rheumatoid arthritis (RA) in Germany, Spain, and the UK, and estimate clinical and healthcare utilization outcomes associated with early versus late treatment. Adults (≥18 years) with a confirmed RA diagnosis between January 2008 and December 2010, who received biologic treatment for ≥3 months and had ≥12 months of follow-up were included. Early treatment was receipt of biologic agent ≤1 year after RA diagnosis. Outcomes included 28-joint disease activity score (DAS28) reduction of ≥1.2 from biologic start and remission (DAS28 < 2.6). Time to outcome was evaluated using Kaplan-Meier curves and log-rank tests. Of 328 patients enrolled (Germany [n = 111], Spain [n = 106], UK [n = 111]), 58.2 % received early biologic (Germany: 55.0 %, UK: 55.9 %, Spain: 64.2 %; p = 0.321). First-line biologics were more frequent in Spain (26.4 %) and Germany (19.8 %) versus the UK (7.2 %; p < 0.001). Late-treated patients were hospitalized more often than early-treated patients (10.5 vs 2.9 % [p = 0.006] for 9.0 vs 5.4 mean inpatient days [p = 0.408]). DAS28 was 5.1 at biologic initiation (n = 310); 73.5 % of patients had a DAS28 decrease of ≥1.2 and 44.5 % achieved remission. More patients had DAS28 decrease of ≥1.2 (79.2 vs 65.9 %; p = 0.009) and remission (51.1 vs 35.6 %; p = 0.007) with early versus late treatment, with a significant difference in Kaplan-Meier curves when indexing on time since diagnosis (p < 0.001) and biologic start (p = 0.024). In RA patients receiving biologic therapy, over half received biologic therapy early. Early initiation was associated with improved clinical outcomes and reduced hospitalization rates versus late treatment.
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Chapeltown Road, Leeds, LS7 4SA, UK. p.emery@leeds.ac.uk.|NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS2 9PH, UK. p.emery@leeds.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.affiliation: Pharmerit International, Bethesda, MD, USA. csolem@pharmerit.com.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Solem
authors.affiliation: Pharmerit International, Rotterdam, The Netherlands. imajer@pharmerit.com.
authors.forename: Istvan
authors.initials: I
authors.lastname: Majer
authors.affiliation: Pfizer Inc., Groton, CT, USA. joseph.c.cappelleri@pfizer.com.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cappelleri
authors.affiliation: Pfizer Italia, Rome, Italy. Miriam.Tarallo@pfizer.com.
authors.forename: Miriam
authors.initials: M
authors.lastname: Tarallo
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D001688:Biological Products / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs / Q000639:trends; D011307:Drug Prescriptions; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D054625:Healthcare Disparities; D017721:Hospital Costs / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Biologic; DAS28; Early biologic treatment; Europe; Rheumatoid arthritis