| Title |
Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry
|
|---|---|
| Published in |
Clinical Rheumatology, January 2017
|
| DOI | 10.1007/s10067-016-3528-y |
| Pubmed ID | |
| Authors |
Sara Monti, Catherine Klersy, Roberto Gorla, Piercarlo Sarzi-Puttini, Fabiola Atzeni, Raffaele Pellerito, Enrico Fusaro, Giuseppe Paolazzi, Pier Andrea Rocchetta, Ennio Giulio Favalli, Antonio Marchesoni, Roberto Caporali |
| Abstract |
According to international recommendations, the selection of the biologic disease modifying anti-rheumatic drug (bDMARD) for rheumatoid arthritis (RA) is mainly left to the clinician's preference. We analyzed the real-life factors influencing the first-line choice or the switching strategy, focusing on the prescription of abatacept (ABA) or tocilizumab (TCZ) compared to TNFα inhibitors (TNFi). Patients enrolled in the Lombardy Rheumatology Network (LORHEN) Registry after January 1, 2010, when all considered bDMARD agents were available, were included. The population was divided into "first-" and "second-line" bDMARD. We included 1910 patients (first line n = 1264, second line n = 646). Age was higher in ABA or TCZ vs TNFi treated patients (p < 0.0001). Positive latent tuberculosis screening was associated with first-line ABA (p = 0.002). Methotrexate (MTX) combination therapy was lower in the TCZ group (p = 0.02). The type (dyslipidemia, hypertension, pulmonary disease) and the number of comorbidities influenced the choice towards ABA (p = 0.01). Multinomial logistic regression demonstrated that a second-line treatment, higher age, dyslipidemia, pulmonary disease, other comorbidities, and extra-articular RA manifestations were associated with ABA compared to TNFi. TCZ was associated with a second-line treatment, higher age, and more severe disease activity. Stopping the first bDMARD due to adverse events (AE) influenced the choice towards ABA. In real life, higher age and comorbidities influence the choice towards ABA and TCZ compared to TNFi. ABA was preferred in case of suspension of previous treatments due to AE. After failing a first-line TNFi, swapping to a different mechanism of action is more common. |
Mendeley readers
The data shown below were compiled from readership statistics for 106 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 106 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 14 | 13% |
| Student > Ph. D. Student | 11 | 10% |
| Other | 9 | 8% |
| Student > Master | 9 | 8% |
| Student > Bachelor | 8 | 8% |
| Other | 19 | 18% |
| Unknown | 36 | 34% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 36 | 34% |
| Pharmacology, Toxicology and Pharmaceutical Science | 8 | 8% |
| Biochemistry, Genetics and Molecular Biology | 6 | 6% |
| Unspecified | 3 | 3% |
| Chemistry | 3 | 3% |
| Other | 8 | 8% |
| Unknown | 42 | 40% |
Attention Score in Context
This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 January 2017.
All research outputs
#4,203,641
of 22,940,083 outputs
Outputs from Clinical Rheumatology
#619
of 3,033 outputs
Outputs of similar age
#84,529
of 421,054 outputs
Outputs of similar age from Clinical Rheumatology
#5
of 35 outputs
Altmetric has tracked 22,940,083 research outputs across all sources so far. Compared to these this one has done well and is in the 80th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,033 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.9. This one has done well, scoring higher than 77% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 421,054 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 78% of its contemporaries.
We're also able to compare this research output to 35 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 82% of its contemporaries.