Acknowledgements
We appreciated the Biostatistics Center, Kaohsiung Chang Gung Memorial
Hospital for statistics work. We also appreciated the Kawasaki Center
and Mitochondria center, Kaohsiung Chang Gung Memorial Hospital for
assistance.
Authors’ contributions
Zon-Min Lee: Drafting the article and revising it critically for
important intellectual content
Yao Hsu Yang: acquisition of data, analysis and interpretation of data
Ho-Chang Kuo: analysis and interpretation of data
Ya-Han Shen: acquisition of data and analysis
Hong-Ren Yu: Agreement to be accountable for all aspects of the work in
ensuring that questions related to the accuracy or integrity of any part
of the work are appropriately investigated and resolved
Yu-Jih Su: Substantial contributions to conception, design, discussion,
and final approval of the version to be published
Declarations
This study has been approved by Institutional Review Board (IRB) of
Chang Gung Memorial Hospital: 201801196B0C501
Competing interests
All authors hereby declare that they have no financial interests to
disclose in relation to this
article.
Funding
This study was funded by the following grants: CFRPG8H0231 from Chang
Gung Memorial Hospital in
Taiwan.
Abstract
Aim: Comparison between early biologics treatment and late biologics
treatment of rheumatoid arthritis (RA) patients in decreasing
prescription days of glucocorticoids and painkillers by using the Taiwan
National Health Insurance Research database from January 1, 1997 to
December 31, 2013.
Method: We defined early use of biologics as biologics prescribed within
2.24 years after the RA diagnosis, and the late use of biologics was
defined as those prescribed after 2.24 years of the RA diagnosis. These
definitions are based on previous studies defining early arthritis as
arthritis within 2 years of diagnosis, while we needed another 3 months
for application biologics here in Taiwan, which equals a total of 2.24
years.
Results: Among the 821 patients, 410 patients (50%) were classified in
the Early group, and the other 411 patients (50%) were classified in
the Late group. The use of any of these three types of medication,
including steroids, disease modifying antirhuematic drugs, and
nonsteroid anti-inflammatory drug (NSAID) was changed significantly
after biologics treatment. Comparing between before and after biologics
treatment, oral medication was significantly tapered (all p
<0.0001). The results show that men are 1.81 times more likely
than women to taper oral glucocorticoids and NSAIDs. Younger age
(<45) patients are 1.91 times more likely to taper steroids
and NSAIDs than those aged over 65 years old. Both gender and age were
found to be independent factors that could decrease days of prescription
of both steroids and NSAIDs in early use of biologics agents.
Conclusion: This study indicates that younger patients only need
short-term (2.53±1.92 years, p=0.03) and early treatment with biologics
(within 2.24 years of diagnosis of RA), just in order to taper steroids
and NSAIDs to less than 50% compared to the steroids and NSAIDs doses
before biologics treatment.
Keywords: rheumatoid arthritis, biological agent, cohort study,
cumulative days, steroid, painkillers, NSAID
Key points:
- Treatment with biologics within 2.24 years of rheumatoid arthritis
lessen the days of prescription of glucocorticoids and painkillers in
12 months. (Table 2)
- Take whole rheumatoid arthritis disease duration into consideration,
using biologics treatment in the early quartile, i.e. using biologics
longer than 75% of disease duration, significantly reduced the
prescription days of steroid. (Table 3)
- Gender and the age by the time of using biologics are two independent
factors associated with decreasing at least half of the prescription
days of glucocorticoids and other traditional treatments. (Table 4)
- The reimbursement of biologics other than the Etanercept and the
Adalimumab as first-line biologics treatment was not available in
Rituximab and Tocilizumab by 2013, and the Golimumab was not available
until the end of 2012, which could limit the case numbers in this
research. (Limitation)