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Starting of biological disease modifying antirheumatic drugs may be postponed in rheumatoid arthritis patients with multimorbidity: Single center real life results.

Abstract The objective of this study was to assess the frequency of comorbidities and multimorbidities in rheumatoid arthritis (RA) patients under biologic therapy and their effects on biological disease modifying antirheumatic drugs (DMARDs) choice, timing, and response.Hacettepe University Biologic Registry (HUR-BIO) is single center biological DMARD registry. Cardiovascular, infectious, cancer, and other comorbidities were recorded with face to face interviews. Multimorbidity is defined as >1 comorbidity. Disease duration, initial date of biological DMARDs, initial and overall biological DMARD choice were recorded. Disease activity score-28 (DAS-28) responses were compared to comorbidity presence and multimorbidity.Total of 998 RA patients were enrolled into the study. The mean age was 53.1 (12.5) and mean disease duration (standard deviation [SD]) was 11.7 (7.5) years. At least 1 comorbidity was detected in 689 (69.1%) patients, 375 (37.9%) patients had multimorbidity. Patients had mean 1.36 ± 1.32 comorbidity. The median durations of first biological DMARDs prescription were 60 (3-552) months after RA diagnosis. For multimorbidity patients, the median first biological prescription duration was longer than the duration for patients without multimorbidity (72 [3-552] vs 60 [3-396] months, P < .001). The physicians prescribe tumor necrosis factor inhibitor (TNFi) biological drugs less frequently than other biological DMARDs in patients with at least 1 comorbidity (66.2% vs 74.5%, P = .007) or multimorbidity (34.6% vs 43.5%, P = .006). Patients with comorbidities and multimorbidity achieved DAS-28 remission less frequently than patients without comorbidity (31.6% vs 42.6%, P = .012 and 27.2% vs 39.7%, P = .001, respectively).In real life, physicians may postpone to prescribe biological DMARDs and less frequently choose TNFi biological drugs in patients with multimorbidity. Furthermore, comorbidity may have a negative effect on the treatment response.
PMID
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Authors

Mayor MeshTerms

Comorbidity

Keywords
Journal Title medicine
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PMID- 29595700
OWN - NLM
STAT- MEDLINE
DCOM- 20180411
LR  - 20180411
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 13
DP  - 2018 Mar
TI  - Starting of biological disease modifying antirheumatic drugs may be postponed in 
      rheumatoid arthritis patients with multimorbidity: Single center real life
      results.
PG  - e9930
LID - 10.1097/MD.0000000000009930 [doi]
AB  - The objective of this study was to assess the frequency of comorbidities and
      multimorbidities in rheumatoid arthritis (RA) patients under biologic therapy and
      their effects on biological disease modifying antirheumatic drugs (DMARDs)
      choice, timing, and response.Hacettepe University Biologic Registry (HUR-BIO) is 
      single center biological DMARD registry. Cardiovascular, infectious, cancer, and 
      other comorbidities were recorded with face to face interviews. Multimorbidity is
      defined as &gt;1 comorbidity. Disease duration, initial date of biological DMARDs,
      initial and overall biological DMARD choice were recorded. Disease activity
      score-28 (DAS-28) responses were compared to comorbidity presence and
      multimorbidity.Total of 998 RA patients were enrolled into the study. The mean
      age was 53.1 (12.5) and mean disease duration (standard deviation [SD]) was 11.7 
      (7.5) years. At least 1 comorbidity was detected in 689 (69.1%) patients, 375
      (37.9%) patients had multimorbidity. Patients had mean 1.36 +/- 1.32 comorbidity.
      The median durations of first biological DMARDs prescription were 60 (3-552)
      months after RA diagnosis. For multimorbidity patients, the median first
      biological prescription duration was longer than the duration for patients
      without multimorbidity (72 [3-552] vs 60 [3-396] months, P &lt; .001). The
      physicians prescribe tumor necrosis factor inhibitor (TNFi) biological drugs less
      frequently than other biological DMARDs in patients with at least 1 comorbidity
      (66.2% vs 74.5%, P = .007) or multimorbidity (34.6% vs 43.5%, P = .006). Patients
      with comorbidities and multimorbidity achieved DAS-28 remission less frequently
      than patients without comorbidity (31.6% vs 42.6%, P = .012 and 27.2% vs 39.7%, P
      = .001, respectively).In real life, physicians may postpone to prescribe
      biological DMARDs and less frequently choose TNFi biological drugs in patients
      with multimorbidity. Furthermore, comorbidity may have a negative effect on the
      treatment response.
FAU - Armagan, Berkan
AU  - Armagan B
AD  - Division of Rheumatology.
FAU - Sari, Alper
AU  - Sari A
AD  - Division of Rheumatology.
FAU - Erden, Abdulsamet
AU  - Erden A
AD  - Division of Rheumatology.
FAU - Kilic, Levent
AU  - Kilic L
AD  - Division of Rheumatology.
FAU - Erdat, Efe Cem
AU  - Erdat EC
AD  - Department of Internal Medicine.
FAU - Kilickap, Saadettin
AU  - Kilickap S
AD  - Division of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara,
      Turkey.
FAU - Kiraz, Sedat
AU  - Kiraz S
AD  - Division of Rheumatology.
FAU - Bilgen, Sule Apras
AU  - Bilgen SA
AD  - Division of Rheumatology.
FAU - Karadag, Omer
AU  - Karadag O
AD  - Division of Rheumatology.
FAU - Akdogan, Ali
AU  - Akdogan A
AD  - Division of Rheumatology.
FAU - Ertenli, Ihsan
AU  - Ertenli I
AD  - Division of Rheumatology.
FAU - Kalyoncu, Umut
AU  - Kalyoncu U
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Age of Onset
MH  - Aged
MH  - Antirheumatic Agents/*therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy/*epidemiology
MH  - Biological Products
MH  - Cardiovascular Diseases/epidemiology
MH  - Communicable Diseases/epidemiology
MH  - *Comorbidity
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multimorbidity
MH  - Neoplasms/epidemiology
EDAT- 2018/03/30 06:00
MHDA- 2018/04/12 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2018/04/12 06:00 [medline]
AID - 10.1097/MD.0000000000009930 [doi]
AID - 00005792-201803300-00073 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Mar;97(13):e9930. doi: 10.1097/MD.0000000000009930.