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Tumour necrosis factor inhibitor exposure and radiographic outcomes in Veterans with rheumatoid arthritis: a longitudinal cohort study

Author

Cannon GW1,2, Erickson AR3, Teng CC1,4, Huynh T1,4, Austin S1,5, Wade SW6, Stolshek BS7, Collier DH8, Mutebi A7, Sauer BC1,4. Rheumatol Adv Pract. 2019 May 28;3(1):rkz015. doi: 10.1093/rap/rkz015. eCollection 2019.

Author Information

1 Salt Lake City VA Medical Center, University of Utah, Salt Lake City, UT, USA.

2 Division of Rheumatology, University of Utah, Salt Lake City, UT, USA.

3 VA Nebraska-Western Iowa Health Care System and Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA.

4 Division of Epidemiology, University of Utah, Salt Lake City, UT, USA.

5 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

6 Wade Outcomes Research and Consulting, Salt Lake City, UT, USA.

7 Global Health Economics, Amgen Inc., USA.

8 Clinical Development, Amgen Inc., Thousand Oaks, CA, USA.

Abstract

OBJECTIVES: 

The aim was to estimate the impact of TNF inhibitor (TNFi) exposure on radiographic disease progression in US Veterans with RA during the first year after initiating therapy.

METHODS: 

This historical longitudinal cohort design used clinical and claims data to evaluate radiographic progression after initiation of TNFi. US Veterans with RA initiating TNFi treatment (index date), ≥ 6 months pre-index and ≥ 12 months post-index VA enrolment/activity, and initial (6 months pre-index to 30 days post-index) and follow-up (10-18 months post-index) bilateral hand radiographs were eligible. The cumulative TNFi exposure and change in modified Sharp score (MSS) between initial and follow-up radiographs were calculated. The percentage of patients with clinically meaningful change in MSS (≥ 5) for each month of exposure was assessed using a longitudinal marginal structural model with inverse probability of treatment weights. Mean values and CIs were generated using 1000 bootstrapped samples.

RESULTS: 

For 246 eligible patients, the mean (s.d.) age was 58 (11) years; 81% were male. The mean (s.d.) initial MSS was 19.6 (33.4) (range 0-214). The mean change (s.d.) in MSS was 0.3 (3.6) (median 0, range -19 to 22). Patients with the greatest exposure had the least radiographic progression for both crude and adjusted model analyses. Adjusted rates of MSS change ≥ 5 points (95% CI) were 10.6% (9.8%, 11.4%) for patients with 3 months of exposure compared with 5.4% (5.1%, 5.7%) for patients with 12 months of exposure.

CONCLUSION: 

One-year changes in radiographic progression were small. Patients with the greatest cumulative TNFi exposure experienced the least progression.