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Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012.

Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A, Karberg K, Wassenberg S, Zink A - RMD Open (2015)

Bottom Line: Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators.In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade.Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany.

ABSTRACT

Objectives: To describe changes in drug treatment and clinical outcomes of ankylosing spondylitis (AS) during the past decade.

Methods: The national database of the German collaborative arthritis centres collects clinical and patient-derived data from unselected outpatients with inflammatory rheumatic diseases. Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators.

Results: Non-steroidal anti-inflammatory drugs (NSAIDs) have been the predominant treatment choice in AS over the years with a prescription rate of 67% of patients in 2012. Currently, almost half of the patients with AS in German rheumatology centres are treated with tumour necrosis factor inhibitors (TNFi). Often, both treatments are used in combination (33%), followed by combinations of NSAIDs and synthetic disease modifying antirheumatic drugs (sDMARDs) with 23% or TNFi alone (21%). In 2012, 10% of patients each received NSAID or sDMARD monotherapy. Methotrexate, sulfasalazine, glucocorticoids and analgaesics alone or in combination with other treatments were given to 10% of patients, respectively. Over the years, we have seen remarkable improvements in disease control and patient reported outcomes. These developments are consistent with enhanced functional status, increasing employment rates and decreasing sick leave, hospitalisation and work disability.

Conclusions: In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade. Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.

No MeSH data available.


Related in: MedlinePlus

Prescription rates of (A) NSAIDs, glucocorticoids and analgaesics, (B) TNF inhibitors and synthetic DMARDs and (C) combination therapy of NSAIDs with TNF inhibitors, NSAIDs with synthetic DMARDs, or monotherapies with NSAIDs, TNF inhibitors or synthetic DMARDS, respectively. (D) Proportions of poorly rated physician-reported and patient-reported outcomes (scores *4–10 or **7–10 on a numerical rating scale with range 0–10). NSAID, non-steroidal anti-inflammatory drug; TNFi, tumour necrosis factor inhibitor; sDMARD, synthetic disease-modifying antirheumatic drug.
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RMDOPEN2014000033F1: Prescription rates of (A) NSAIDs, glucocorticoids and analgaesics, (B) TNF inhibitors and synthetic DMARDs and (C) combination therapy of NSAIDs with TNF inhibitors, NSAIDs with synthetic DMARDs, or monotherapies with NSAIDs, TNF inhibitors or synthetic DMARDS, respectively. (D) Proportions of poorly rated physician-reported and patient-reported outcomes (scores *4–10 or **7–10 on a numerical rating scale with range 0–10). NSAID, non-steroidal anti-inflammatory drug; TNFi, tumour necrosis factor inhibitor; sDMARD, synthetic disease-modifying antirheumatic drug.

Mentions: Figure 1 shows the development of the pharmacological treatment of patients with AS in routine care. As the first choice therapy, NSAIDs were prescribed to 69% of patients in 2000 and to 67% of patients in 2012 (figure 1A). In particular, the rate of non-selective NSAIDs declined by 17% until 2004 (p<0.01) with a concurrent rise in the use of cox-2 inhibitors by 18% (p<0.01). In 2012, 52% of patients received non-selective NSAIDs and 22% of patients received coxibs. The prescription rates of glucocorticoids decreased from 18% (2000) to 10% (2012) (p<0.001). The proportion of patients who received higher doses of glucocorticoids (>7.5 mg/d) receded from 3.1% to 1.8%. Analgaesics were used in 5–21% of the patients across the years.


Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012.

Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A, Karberg K, Wassenberg S, Zink A - RMD Open (2015)

Prescription rates of (A) NSAIDs, glucocorticoids and analgaesics, (B) TNF inhibitors and synthetic DMARDs and (C) combination therapy of NSAIDs with TNF inhibitors, NSAIDs with synthetic DMARDs, or monotherapies with NSAIDs, TNF inhibitors or synthetic DMARDS, respectively. (D) Proportions of poorly rated physician-reported and patient-reported outcomes (scores *4–10 or **7–10 on a numerical rating scale with range 0–10). NSAID, non-steroidal anti-inflammatory drug; TNFi, tumour necrosis factor inhibitor; sDMARD, synthetic disease-modifying antirheumatic drug.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612682&req=5

RMDOPEN2014000033F1: Prescription rates of (A) NSAIDs, glucocorticoids and analgaesics, (B) TNF inhibitors and synthetic DMARDs and (C) combination therapy of NSAIDs with TNF inhibitors, NSAIDs with synthetic DMARDs, or monotherapies with NSAIDs, TNF inhibitors or synthetic DMARDS, respectively. (D) Proportions of poorly rated physician-reported and patient-reported outcomes (scores *4–10 or **7–10 on a numerical rating scale with range 0–10). NSAID, non-steroidal anti-inflammatory drug; TNFi, tumour necrosis factor inhibitor; sDMARD, synthetic disease-modifying antirheumatic drug.
Mentions: Figure 1 shows the development of the pharmacological treatment of patients with AS in routine care. As the first choice therapy, NSAIDs were prescribed to 69% of patients in 2000 and to 67% of patients in 2012 (figure 1A). In particular, the rate of non-selective NSAIDs declined by 17% until 2004 (p<0.01) with a concurrent rise in the use of cox-2 inhibitors by 18% (p<0.01). In 2012, 52% of patients received non-selective NSAIDs and 22% of patients received coxibs. The prescription rates of glucocorticoids decreased from 18% (2000) to 10% (2012) (p<0.001). The proportion of patients who received higher doses of glucocorticoids (>7.5 mg/d) receded from 3.1% to 1.8%. Analgaesics were used in 5–21% of the patients across the years.

Bottom Line: Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators.In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade.Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany.

ABSTRACT

Objectives: To describe changes in drug treatment and clinical outcomes of ankylosing spondylitis (AS) during the past decade.

Methods: The national database of the German collaborative arthritis centres collects clinical and patient-derived data from unselected outpatients with inflammatory rheumatic diseases. Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators.

Results: Non-steroidal anti-inflammatory drugs (NSAIDs) have been the predominant treatment choice in AS over the years with a prescription rate of 67% of patients in 2012. Currently, almost half of the patients with AS in German rheumatology centres are treated with tumour necrosis factor inhibitors (TNFi). Often, both treatments are used in combination (33%), followed by combinations of NSAIDs and synthetic disease modifying antirheumatic drugs (sDMARDs) with 23% or TNFi alone (21%). In 2012, 10% of patients each received NSAID or sDMARD monotherapy. Methotrexate, sulfasalazine, glucocorticoids and analgaesics alone or in combination with other treatments were given to 10% of patients, respectively. Over the years, we have seen remarkable improvements in disease control and patient reported outcomes. These developments are consistent with enhanced functional status, increasing employment rates and decreasing sick leave, hospitalisation and work disability.

Conclusions: In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade. Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.

No MeSH data available.


Related in: MedlinePlus