Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients: a multicenter international study

Francisco de Assis Acurcio, Augusto Afonso Guerra Júnior, Michael Ruberson Ribeiro da Silva, Ramon Gonçalves Pereira, Brian Godman, Marion Bennie, Hacene Nedjar, Elham Rahme

Research output: Contribution to journalArticle

Abstract

Objective. To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis(AS) living in Brazil and Quebec, Canada.
Methods. We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation.
Results. One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1% and 30.7%, Quebec: 66.9% and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9% and 18.1%, Quebec: 51.5% and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.
Conclusions. Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.
Original languageEnglish
JournalCurrent Medical Research and Opinion
Publication statusAccepted/In press - 22 Jan 2020

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Quebec
Ankylosing Spondylitis
Multicenter Studies
Brazil
Tumor Necrosis Factor-alpha
Antirheumatic Agents
Therapeutics
Human Development
Social Class
Canada
Comorbidity
Cohort Studies
Regression Analysis
Health

Keywords

  • ankylosing spondylitis
  • anti-TNF agents
  • conventioanl DMARDs
  • medication persistence
  • cohort

Cite this

Acurcio, Francisco de Assis ; Guerra Júnior, Augusto Afonso ; da Silva, Michael Ruberson Ribeiro ; Gonçalves Pereira, Ramon ; Godman, Brian ; Bennie, Marion ; Nedjar, Hacene ; Rahme, Elham. / Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients : a multicenter international study. In: Current Medical Research and Opinion. 2020.
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abstract = "Objective. To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis(AS) living in Brazil and Quebec, Canada. Methods. We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. Results. One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1{\%} and 30.7{\%}, Quebec: 66.9{\%} and 67.0{\%}). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9{\%} and 18.1{\%}, Quebec: 51.5{\%} and 53.5{\%}). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.Conclusions. Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.",
keywords = "ankylosing spondylitis, anti-TNF agents, conventioanl DMARDs, medication persistence, cohort",
author = "Acurcio, {Francisco de Assis} and {Guerra J{\'u}nior}, {Augusto Afonso} and {da Silva}, {Michael Ruberson Ribeiro} and {Gon{\cc}alves Pereira}, Ramon and Brian Godman and Marion Bennie and Hacene Nedjar and Elham Rahme",
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Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients : a multicenter international study. / Acurcio, Francisco de Assis; Guerra Júnior, Augusto Afonso; da Silva, Michael Ruberson Ribeiro; Gonçalves Pereira, Ramon; Godman, Brian; Bennie, Marion; Nedjar, Hacene; Rahme, Elham.

In: Current Medical Research and Opinion, 22.01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients

T2 - a multicenter international study

AU - Acurcio, Francisco de Assis

AU - Guerra Júnior, Augusto Afonso

AU - da Silva, Michael Ruberson Ribeiro

AU - Gonçalves Pereira, Ramon

AU - Godman, Brian

AU - Bennie, Marion

AU - Nedjar, Hacene

AU - Rahme, Elham

PY - 2020/1/22

Y1 - 2020/1/22

N2 - Objective. To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis(AS) living in Brazil and Quebec, Canada. Methods. We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. Results. One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1% and 30.7%, Quebec: 66.9% and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9% and 18.1%, Quebec: 51.5% and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.Conclusions. Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.

AB - Objective. To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis(AS) living in Brazil and Quebec, Canada. Methods. We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. Results. One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1% and 30.7%, Quebec: 66.9% and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9% and 18.1%, Quebec: 51.5% and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy.Conclusions. Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.

KW - ankylosing spondylitis

KW - anti-TNF agents

KW - conventioanl DMARDs

KW - medication persistence

KW - cohort

M3 - Article

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

ER -