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Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis.

Publication ,  Journal Article
Dewitt, EM; Li, Y; Curtis, JR; Glick, HA; Greenberg, JD; Anstrom, KJ; Kremer, JM; Reed, G; Schulman, KA; Reed, SD
Published in: J Rheumatol
February 2013

OBJECTIVE: To evaluate the comparative effectiveness of nonbiologic disease-modifying antirheumatic drugs (DMARD) versus biologic DMARD (bDMARD) for treatment of rheumatoid arthritis (RA), using 2 common analytic approaches. METHODS: We analyzed change in Clinical Disease Activity Index (CDAI) scores in patients with RA enrolled in a US-based observational registry from 2001 to 2008 using multivariable (MV) regression and propensity score (PS) matching. Among patients who initiated treatment with a nonbiologic DMARD (n = 1729), we compared patients who switched to, or added, another nonbiologic (n = 182) or a bDMARD (n = 342) at 5, 9, and 24 months after treatment change. RESULTS: Both analytic approaches showed that patients switching to or adding another nonbiologic DMARD demonstrated improvement across 9 and 24 months (both p < 0.001). Both approaches also demonstrated greater improvement in CDAI among recipients of bDMARD relative to a second nonbiologic DMARD at 5 months (p < 0.02). The MV regression approach upheld these results at 9 and 24 months (p < 0.03). In contrast, the PS-matching approach did not show a sustained advantage with bDMARD at these later timepoints, possibly because of lower statistical power and/or lower baseline disease activity in the PS-matched cohort. CONCLUSION: Patients in both treatment groups generally experienced lower CDAI scores across time. Patients switching to bDMARD demonstrated greater improvement than patients switching to nonbiologic DMARD with both analytic approaches at 5 months. Relative advantages with bDMARD were observed at 9 and 24 months only with MV regression. These analyses provide a practical example of how findings in comparative effectiveness research can diverge with different methodological approaches.

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Published In

J Rheumatol

DOI

EISSN

1499-2752

Publication Date

February 2013

Volume

40

Issue

2

Start / End Page

127 / 136

Location

Canada

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Regression Analysis
  • Registries
  • Propensity Score
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Dewitt, E. M., Li, Y., Curtis, J. R., Glick, H. A., Greenberg, J. D., Anstrom, K. J., … Reed, S. D. (2013). Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis. J Rheumatol, 40(2), 127–136. https://doi.org/10.3899/jrheum.120400
Dewitt, Esi Morgan, Yanhong Li, Jeffrey R. Curtis, Henry A. Glick, Jeffrey D. Greenberg, Kevin J. Anstrom, Joel M. Kremer, George Reed, Kevin A. Schulman, and Shelby D. Reed. “Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis.J Rheumatol 40, no. 2 (February 2013): 127–36. https://doi.org/10.3899/jrheum.120400.
Dewitt EM, Li Y, Curtis JR, Glick HA, Greenberg JD, Anstrom KJ, et al. Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis. J Rheumatol. 2013 Feb;40(2):127–36.
Dewitt, Esi Morgan, et al. “Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis.J Rheumatol, vol. 40, no. 2, Feb. 2013, pp. 127–36. Pubmed, doi:10.3899/jrheum.120400.
Dewitt EM, Li Y, Curtis JR, Glick HA, Greenberg JD, Anstrom KJ, Kremer JM, Reed G, Schulman KA, Reed SD. Comparative effectiveness of nonbiologic versus biologic disease-modifying antirheumatic drugs for rheumatoid arthritis. J Rheumatol. 2013 Feb;40(2):127–136.

Published In

J Rheumatol

DOI

EISSN

1499-2752

Publication Date

February 2013

Volume

40

Issue

2

Start / End Page

127 / 136

Location

Canada

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Regression Analysis
  • Registries
  • Propensity Score
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female