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系統識別號 U0026-2401201312074900
論文名稱(中文) 臺灣類風濕性關節炎病患使用DMARDs之處方型態分析
論文名稱(英文) Prescribing Pattern of Disease-Modifying Anti-rheumatic Drugs in Established Rheumatoid Arthritis Patients in Taiwan
校院名稱 成功大學
系所名稱(中) 臨床藥學與藥物科技研究所
系所名稱(英) Institute of Clinical Pharmacy and Pharmaceutical sciences
學年度 101
學期 1
出版年 102
研究生(中文) 黃昱穎
研究生(英文) Yu-Yin Huang
學號 S66991045
學位類別 碩士
語文別 中文
論文頁數 109頁
口試委員 指導教授-高雅慧
口試委員-嵇允嬋
口試委員-劉明煇
口試委員-張慧真
口試委員-翁孟玉
中文關鍵字 疾病修飾抗風濕病藥物  類風濕性關節炎  處方型態 
英文關鍵字 DMARDs  Rheumatoid arthritis  Prescribing patterns 
學科別分類
中文摘要 研究背景
類風濕性關節炎為慢性、發炎性的疾病,以侵犯關節為主,未接受治療常導致患者疼痛、關節破壞變形、失能、早發性死亡,也明顯增加心血管疾病、感染、骨質疏鬆罹病率和死亡率。及早開始、適時調整傳統DMARDs與生物製劑使用證實可顯著改善類風濕性關節炎病患的預後。目前類風濕性關節炎無法治癒,持續的疾病活性和關節破壞的進展有直接相關性。因此,使疾病達到緩解或低疾病活性是治療努力的目標。然而,DMARDs治療選擇與策略使用在臺灣類風濕性關節炎病患常規照護之相關研究仍屬少數。本研究之目的即在於瞭解臺灣類風濕性關節炎患者DMARDs治療型態及近幾年臨床治療的趨勢變化。

研究方法
利用2001年至2010年全民健保資料庫,研究對象納入2002/01/01 -2009/12/31間新通過類風濕性關節炎重大傷病卡申請的患者,申請者必須符合1987年ACR類風濕性關節炎分類標準。以重大傷病卡申請日期當作指標日期,於病患確診時、確診後第30天、第90天、第180天、第365天五個不同時間點觀察DMARDs使用情形。另外,同時亦針對確診後一年內TNF-α inhibitors新使用者進行分析,評估TNF-α inhibitors和傳統DMARDs合併治療情形。

研究結果
經由納入、排除條件篩選後,研究對象共21,196人,平均年齡54歲,女性佔77.4%。病患確診時,82.5%RA患者接受DMARDs治療,未接受DMARDs治療的病患有逐年下降趨勢,2002年到2009年,從22.1%下降至13.3%。48.8% RA患者接受DMARDs合併治療且逐年明顯增加,DMARDs單一治療則呈現逐年下降趨勢,合併口服類固醇治療比率約51.6%。Hydroxychloroquine、sulfasalazine、methotrexate是三種最常被開立的DMARDs,MTX的使用率在不同觀察時間點逐漸超越sulfasalazine、hydroxychloroquine。在確診後一年,TNF-α inhibitors的使用明顯逐年增加,2002年到2009年,從0.1%上升至7.6%。84%TNF-α inhibitor使用者至少合併一種以上傳統DMARDs,與MTX併用比率約74%。

研究結論
本研究顯示臺灣對於類風濕性關節炎患者傾向採取越來越積極的治療。DMARDs使用、DMARDs合併治療皆有明顯逐年增加趨勢,特別是MTX為主的治療組合。整體上,臺灣類風濕性關節炎患者的治療與國際治療趨勢一致。
英文摘要 Background
Rheumatoid arthritis (RA) is a chronic inflammatory condition affecting the joints most. When untreated, RA causes pain, continuing joints damage and deformity, disability, and premature mortality in most patients. RA also increases disease morbidity and mortality, especially cardiovascular disease, infection and osteoporosis. Early initiation and timely escalation of treatment with conventional disease-modifying anti-rheumatic drugs(DMARDs) and the initiation of treatment with biologic DMARDs can significantly improve the prognosis. For now, RA can’t be cured and disease activity is thought to be related to radiologic progression. The goal of treatment is to achieve a state of clinical remission or low disease activity. However, little is known of the extent to which treatment options and strategies have entered routine care in Taiwan. Therefore, this study was aimed to investigate the prescribing pattern of DMARDs in established RA patients and the changes in patterns of DMARDs utilization.

Methods
We conducted a cross-sectional study by using 2001-2010 Taiwan’s National Health Insurance Research Database. We identified patients who was issued a catastrophic illness certificate for RA (ICD code: 7140) for the first time during the period from January 1, 2002 through December 31, 2009 and patients must fulfill the 1987 ACR criteria. We estimated DMARDs utilization using cross-sectional assessments and defined the date of application for catastrophic illness certificate as index date, and observed DMARDs prescribing patterns at different time point after the index date. In addiction, if patients started their first TNF-α inhibitors prescription after the first year of the index date, we analyzed how TNF-α inhibitors were being used in clinical practice.

Results
During the study period, we identified 21,196 patients with RA. The mean age was 54 years; the average proportion of female patients was 77.4%. Approximately, 82.5% of RA patients received DMARDs on the index date. The proportion of patients without DMARDs prescription on the index date decreased from 22.1% in 2002 to 13% in 2009. A continuous increase in combination DMARDs therapy and a decrease in monotherapy were observed. 51.6% of RA patients were co-prescribing oral steroids.
Hydroxychloroquine, sulfasalazine, methotrexate were the three most prescribed DMARDs. At different observed time point, the utilization of methotrexate had a trend to surpass the utilization of sulfasalazine and hydroxychloroquine during the study period. At the first year after the index date, the use of TNF-α inhibitors increased from 0.1% of patients in 2002 to 7.6% in 2009. The percentage of patients initiated on TNF-α inhibitors in combination with any conventional DMARDs was 84%, while combination with methotrexate was about 74%.

Conclusions
This study showed the utilization of DMARDs increased in Taiwan with RA, especially combination therapy including methotrexate. Overall, there was a trend toward more aggressive management of RA in Taiwan and in accordance with international trends.
論文目次 中文摘要 I
Abstract III
目錄 VII
表目錄 IX
圖目錄 XII
第一篇 臺灣類風濕性關節炎病患使用DMARDs之處方型態分析 1
第一章 研究背景 1
第二章 文獻回顧 3
第一節 類風濕性關節炎簡介 3
第二節 Disease-modifying antirheumatic drugs(DMARDs)藥品 10
第三節 DMARDs處方型態分析與治療趨勢 27
第三章 研究目的 34
第四章 研究方法 35
第一節 研究設計 35
第二節 研究變項與操作定義 40
第三節 研究藥品與研究結果測量 43
第四節 資料處理流程 46
第五節 統計方法 47
第五章 研究結果 48
第一節 研究對象納入與排除 48
第二節 研究對象之人口學特性 50
第三節 DMARDs處方型態分析 53
第六章 研究討論 70
第一節 研究對象納入與排除之分析 70
第二節 研究對象之人口學特性 72
第三節 DMARDs處方型態分析 73
第四節 服藥順從性 79
第五節 研究優勢與限制 83
第七章 結論與建議 84
第八章 未來研究方向 85
第二篇 臨床藥事服務:類風濕性關節炎病患之服藥順從性 86
第一章 服務背景 86
第二章 服務目的與進行方法 88
第一節 服務目的 88
第二節 服務進行方法 88
第三章 服務結果 90
第一節 研究對象之基本資料與DMARDs藥品使用情形 90
第二節 服藥順從性 90
第三節 DMARDs藥物信念 93
第四節 順從性佳與不佳者之比較 95
第四章 討論與建議 96
參考文獻 98
附錄 107

表目錄
第一篇 臺灣類風濕性關節炎病患使用DMARDs之處方型態分析 1
表2-1 2010新類風濕性關節炎的分類準則 4
表2-2 Disease Activity Measures 9
表2-3 Conventional disease-modifying antirheumatic drugs
used in the treatment of rheumatoid arthritis 23
表2-4 Biologic disease-modifying antirheumatic drugs used
in the treatment of rheumatoid arthritis 24
表2-5 傳統DMARDs與生物製劑之使用禁忌 25
表2-6 DMARDs prescribing patterns in different countries
32
表2-7 DMARDs prescribing patterns in different countries
(續) 33
表4-1 各檔案間串檔變項說明 35
表4-2 研究疾病與診斷碼對照 42
表4-3 研究藥品與ATC對照表 45
表5-1 研究對象之基本資料 51
表5-2 研究對象之基本資料(續) 52
表5-3 Proportions of patients using individual DMARDs at
the index date 57
表5-4 Proportions of DMARDs in monotherapy and combination
regimens at the index date 58
表5-5 Proportions of patients using individual DMARDs at
the first month after the index date 59
表5-6 Proportions of DMARDs in monotherapy and combination
regimens at the first month after the index date 60
表5-7 Proportions of patients using individual DMARDs at
three months after the index date 61
表5-8 Proportions of DMARDs in monotherapy and combination
regimens at three months after the index date 62
表5-9 Proportions of patients using individual DMARDs at
six months after the index date 63
表5-10 Proportions of DMARDs in monotherapy and combination
regimens at six months after the index date 64
表5-11 Proportions of patients using individual DMARDs at
one year after the index date 65
表5-12 Proportions of DMARDs in monotherapy and combination
regimens at one year after the index date 66
表5-13 Details of DMARDs therapy at start of TNF-α
inhibitors 67
表5-14 Different DMARDs combination regimens at one year
after the index date 68
表5-15 Different DMARDs combination regimens at one year
after the index date(續)69
表6-1 指標日期接受DMARDs治療的患者,其他觀察時間點上持續使用DMARDs
情形 81
表6-2 Studies reporting rate of medication adherence 82

第二篇 臨床藥事服務 89
Table 3-1 受訪者之基本資料、藥物順從性與藥物信念評估分數 91
Table 3-2 目前受訪者DMARDs藥品使用情形 92
Table 3-3 DMARDs藥物信念評估 93
Table 3-4 服藥順從性佳或不佳者之基本資料 94
Table 3-5 服藥順從性佳或不佳者之藥物信念 95

圖目錄
圖2-1 Algorithm for treating rheumatoid arthritis to
target 8
圖4-1 研究設計 38
圖4-2 研究流程圖 39
圖4-3 研究藥品使用定義 44
圖5-1 研究對象納入與排除 49
圖5-2 指標日期與指標日期後一年TNF-α inhibitors使用率 55
圖5-3 DMARDs combination and observed DMARDs combination
regimens 56
圖6-1 不同觀察時間點未使用DMARDs比率 81
圖6-2 RA病患於五個觀察時間點使用DMARDs的累積百分比 81
參考文獻 1. Filipovic I, Walker D, Forster F, Curry AS: Quantifying the economic burden of productivity loss in rheumatoid arthritis. Rheumatology 2011, 50(6):1083-1090.
2. Rindfleisch JA, Muller D: Diagnosis and Management of Rheumatoid Arthritis. Am Fam Physician 2005, 72(6):1037-1047.
3. O'Dell JR: Therapeutic strategies for rheumatoid arthritis. New England Journal of Medicine 2004, 350(25):2591-2602.
4. Lee DM, Weinblatt ME: Rheumatoid arthritis. The Lancet 2001, 358(9285):903-911.
5. Choy EH, Smith C, Dore CJ, Scott DL: A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology 2005, 44(11):1414-1421.
6. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, Combe B, Cutolo M, de Wit M, Dougados M et al: Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of the rheumatic diseases 2010, 69(4):631-637.
7. Scott DL, Wolfe F, Huizinga TW: Rheumatoid arthritis. The Lancet 2010, 376(9746):1094-1108.
8. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD et al: 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Annals of the rheumatic diseases 2010, 69(9):1580-1588.
9. Tobon GJ, Youinou P, Saraux A: The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis. Autoimmunity reviews 2010, 9(5):A288-292.
10. Alamanos Y, Voulgari PV, Drosos AA: Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Seminars in arthritis and rheumatism 2006, 36(3):182-188.
11. Lee D, Weinblatt M: Rheumatoid arthritis. The Lancet 2001, 358(9285):903-911.
12. Chou CT PL, Chang DM, Lee CF, Schumacher HR, Liang MH: Prevalence of rheumatic diseases in Taiwan: a population study of urban, suburban, rural differences. The Journal of rheumatology 1994, 21(2):302-306.
13. Lai CH, Lai MS, Lai KL, Chen HH, Chiu YM: Nationwide population-based epidemiologic study of rheumatoid arthritis in Taiwan. Clin Exp Rheumatol 2012, 30(3):358-363.
14. Kuo C-F, Luo S-F, See L-C, Chou IJ, Chang H-C, Yu K-H: Rheumatoid arthritis prevalence, incidence, and mortality rates: a nationwide population study in Taiwan. Rheumatology international 2012:Mar 27. [Epub ahead of print].
15. Myasoedova E, Davis JM, 3rd, Crowson CS, Gabriel SE: Epidemiology of rheumatoid arthritis: rheumatoid arthritis and mortality. Current rheumatology reports 2010, 12(5):379-385.
16. Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D: Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Annals of the rheumatic diseases 2012, 71(9):1524-1529.
17. McInnes IB, Schett G: The Pathogenesis of Rheumatoid Arthritis. New England Journal of Medicine 2011, 365(23):2205-2219.
18. Michaud K, Wolfe F: Comorbidities in rheumatoid arthritis. Best practice & research Clinical rheumatology 2007, 21(5):885-906.
19. Jacobs JWG: Optimal use of non-biologic therapy in the treatment of rheumatoid arthritis. Rheumatology 2012, 51 (Suppl 4):iv3-iv8.
20. Cush JJ: Early rheumatoid arthritis -- is there a window of opportunity? The Journal of rheumatology 2007, 80:1-7.
21. Quinn MA, Emery P: Window of opportunity in early rheumatoid arthritis: possibility of altering the disease process with early intervention. Clin Exp Rheumatol 2003, 21(5 Suppl 31):S154-157.
22. Welsing PM, Landewe RB, van Riel PL, Boers M, van Gestel AM, van der Linden S, Swinkels HL, van der Heijde DM: The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis. Arthritis and rheumatism 2004, 50(7):2082-2093.
23. Bykerk VP, Akhavan P, Hazlewood GS, Schieir O, Dooley A, Haraoui B, Khraishi M, Leclercq SA, Legare J, Mosher DP et al: Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs. The Journal of rheumatology 2012, 39(8):1559-1582.
24. Amjadi S, Ranganath V, Furst D: Disease-Modifying Antirheumatic Drug Use in Older Rheumatoid Arthritis Patients. In: Geriatric Rheumatology edn. Edited by Nakasato Y, Yung RL: Springer New York; 2011: 151-172.
25. Díaz-Borjón A: Guidelines for the Use of Conventional and Newer Disease Modifying Antirheumatic Drugs in Elderly Patients with Rheumatoid Arthritis. Drugs & Aging 2009, 26(4):273-293.
26. Felson DT AJ, Meenan RF: Use of short-term efficacy/toxicity tradeoffs to select second-line drugs in rheumatoid arthritis. A metaanalysis of published clinical trials. Arthritis and rheumatism 1992, 35(10):1117-1125.
27. Edwards CJ, Arden NK, Fisher D, Saperia JC, Reading I, Van Staa TP, Cooper C: The changing use of disease-modifying anti-rheumatic drugs in individuals with rheumatoid arthritis from the United Kingdom General Practice Research Database. Rheumatology (Oxford) 2005, 44(11):1394-1398.
28. Smolen JS, Landewe R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, Gorter S, Knevel R, Nam J, Schoels M et al: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Annals of the rheumatic diseases 2010, 69(6):964-975.
29. Jacobs JWG: Lessons for the use of non-biologic anchor treatments for rheumatoid arthritis in the era of biologic therapies. Rheumatology 2012, 51 (Suppl 4):iv27-33.
30. Moreland LW, O'Dell JR, Paulus HE, Curtis JR, Bathon JM, St Clair EW, Bridges SL, Jr., Zhang J, McVie T, Howard G et al: A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: The treatment of early aggressive rheumatoid arthritis trial. Arthritis and rheumatism 2012, 64(9):2824-2835.
31. Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, Singh A, Pedersen RD, Koenig AS, Freundlich B: Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. The Lancet 2008, 372(9636):375-382.
32. van Vollenhoven RF, Geborek P, Forslind K, Albertsson K, Ernestam S, Petersson IF, Chatzidionysiou K, Bratt J: Conventional combination treatment versus biological treatment in methotrexate-refractory early rheumatoid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial. The Lancet 2012, 379(9827):1712-1720.
33. Westlake SL, Colebatch AN, Baird J, Kiely P, Quinn M, Choy E, Ostor AJ, Edwards CJ: The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology 2010, 49(2):295-307.
34. Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J, Bombardier C, Carmona L, van der Heijde D, Bijlsma JWJ et al: Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Annals of the rheumatic diseases 2009, 68(7):1086-1093.
35. Donahue KE GG, Jonas DE, Lux LJ, Thieda P, Jonas BL, Hansen RA, Morgan LC, Lohr KN: Systematic Review: Comparative Effectiveness and Harms of Disease-Modifying Medications for Rheumatoid Arthritis. Ann Intern Med 2008, 148(2):124-134.
36. American College of Rheumatology Subcommittee. Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis and rheumatism 2002, 46(2):328-346.
37. Feely MG, O'Dell JR: Update on the use of conventional disease-modifying antirheumatic drugs in the management of rheumatoid arthritis. Current opinion in rheumatology 2010, 22(3):316-320.
38. ME S-A, Belseck E SB, Homik J, Wells G, Tugwell P: Antimalarials for treating rheumatoid arthritis. Cochrane database of systematic reviews 2000(4):CD000959.
39. Alcorn N, Saunders S, Madhok R: Benefit-risk assessment of leflunomide: an appraisal of leflunomide in rheumatoid arthritis 10 years after licensing. Drug Saf 2009, 32(12):1123-1134.
40. Behrens F, Koehm M, Burkhardt H: Update 2011: leflunomide in rheumatoid arthritis - strengths and weaknesses. Current opinion in rheumatology 2011, 23(3):282-287.
41. Golicki D NM, Lis J, Pol K, Hermanowski T, Tłustochowicz M.: Leflunomide in monotherapy of rheumatoid arthritis: meta-analysis of randomized trials. Pol Arch Med Wewn 2012, 122(1-2):22-32.
42. Gaujoux-Viala C, Smolen JS, Landewe R, Dougados M, Kvien TK, Mola EM, Scholte-Voshaar M, van Riel P, Gossec L: Current evidence for the management of rheumatoid arthritis with synthetic disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Annals of the rheumatic diseases 2010, 69(6):1004-1009.
43. Clark P, Tugwell P, Bennet K, Bombardier C, Shea B, Wells G, Suarez-Almazor ME: Injectable gold for rheumatoid arthritis. Cochrane database of systematic reviews 2000(2):CD000520.
44. American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis and rheumatism 1996, 39(5):723-731.
45. Suarez-Almazor ME, Spooner C, Belseck E: Penicillamine for treating rheumatoid arthritis. Cochrane database of systematic reviews 2000(4):CD001460.
46. Suarez-Almazor ME, Spooner C, Belseck E: Azathioprine for treating rheumatoid arthritis. Cochrane database of systematic reviews 2000(4):CD001461.
47. Furst DE, Keystone EC, Fleischmann R, Mease P, Breedveld FC, Smolen JS, Kalden JR, Braun J, Bresnihan B, Burmester GR et al: Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009. Annals of the rheumatic diseases 2010, 69 (Suppl 1):i2-29.
48. Aaltonen KJ, Virkki LM, Malmivaara A, Konttinen YT, Nordstrom DC, Blom M: Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. PloS one 2012, 7(1):e30275.
49. Nam JL, Winthrop KL, van Vollenhoven RF, Pavelka K, Valesini G, Hensor EM, Worthy G, Landewe R, Smolen JS, Emery P et al: Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of RA. Annals of the rheumatic diseases 2010, 69(6):976-986.
50. Woodrick RS, Ruderman EM: Safety of biologic therapy in rheumatoid arthritis. Nature reviews Rheumatology 2011, 7(11):639-652.
51. Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Fu B, Ustianowski AP, Watson KD, Lunt M, Symmons DP, Consortium BCC et al: Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology 2011, 50(1):124-131.
52. Mariette X, Matucci-Cerinic M, Pavelka K, Taylor P, van Vollenhoven R, Heatley R, Walsh C, Lawson R, Reynolds A, Emery P: Malignancies associated with tumour necrosis factor inhibitors in registries and prospective observational studies: a systematic review and meta-analysis. Annals of the rheumatic diseases 2011, 70(11):1895-1904.
53. Agarwal SK: Biologic agents in rheumatoid arthritis: an update for managed care professionals. Journal of managed care pharmacy 2011, 17(9 Suppl B):S14-18.
54. Lee YH, Bae SC, Song GG: The efficacy and safety of rituximab for the treatment of active rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials. Rheumatology international 2011, 31(11):1493-1499.
55. Korhonen R, Moilanen E: Anti-CD20 Antibody Rituximab in the Treatment of Rheumatoid Arthritis. Basic & Clinical Pharmacology & Toxicology 2009, 106:13-21.
56. Schiff M: Abatacept treatment for rheumatoid arthritis. Rheumatology 2011, 50(3):437-449.
57. Salliot C, Finckh A, Katchamart W, Lu Y, Sun Y, Bombardier C, Keystone E: Indirect comparisons of the efficacy of biological antirheumatic agents in rheumatoid arthritis in patients with an inadequate response to conventional disease-modifying antirheumatic drugs or to an anti-tumour necrosis factor agent: a meta-analysis. Annals of the rheumatic diseases 2011, 70(2):266-271.
58. Maxwell L, Singh JA: Abatacept for rheumatoid arthritis. Cochrane database of systematic reviews 2009(4):CD007277.
59. Navarro-Millan I, Singh JA, Curtis JR: Systematic review of tocilizumab for rheumatoid arthritis: a new biologic agent targeting the interleukin-6 receptor. Clinical therapeutics 2012, 34(4):788-802 e783.
60. Singh JA, Beg S, Lopez-Olivo MA: Tocilizumab for rheumatoid arthritis: a Cochrane systematic review. The Journal of rheumatology 2011, 38(1):10-20.
61. Kremer JM, Blanco R, Brzosko M, Burgos-Vargas R, Halland AM, Vernon E, Ambs P, Fleischmann R: Tocilizumab inhibits structural joint damage in rheumatoid arthritis patients with inadequate responses to methotrexate: results from the double-blind treatment phase of a randomized placebo-controlled trial of tocilizumab safety and prevention of structural joint damage at one year. Arthritis and rheumatism 2011, 63(3):609-621.
62. Mertens M, Singh JA: Anakinra for rheumatoid arthritis: a systematic review. The Journal of rheumatology 2009, 36(6):1118-1125.
63. Singh JA, Christensen R, Wells GA, Suarez-Almazor ME, Buchbinder R, Lopez-Olivo MA, Ghogomu ET, Tugwell P: A network meta-analysis of randomized controlled trials of biologics for rheumatoid arthritis: a Cochrane overview. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2009, 181(11):787-796.
64. Breedveld FC, Combe B: Understanding emerging treatment paradigms in rheumatoid arthritis. Arthritis research & therapy 2011, 13:1-10.
65. Sesin CA, Bingham CO: Remission in rheumatoid arthritis: wishful thinking or clinical reality? Seminars in arthritis and rheumatism 2005, 35(3):185-196.
66. Ma MH, Scott IC, Kingsley GH, Scott DL: Remission in early rheumatoid arthritis. The Journal of rheumatology 2010, 37(7):1444-1453.
67. Katchamart W, Trudeau J, Phumethum V, Bombardier C: Efficacy and toxicity of methotrexate (MTX) monotherapy versus MTX combination therapy with non-biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a systematic review and meta-analysis. Annals of the rheumatic diseases 2009, 68(7):1105-1112.
68. Pavelka K, Kavanaugh AF, Rubbert-Roth A, Ferraccioli G: Optimizing outcomes in rheumatoid arthritis patients with inadequate responses to disease-modifying anti-rheumatic drugs. Rheumatology 2012, 51 (Suppl 5):v12-21.
69. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, Paulus HE, Mudano A, Pisu M, Elkins-Melton M et al: American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis and rheumatism 2008, 59(6):762-784.
70. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, Moreland LW, O'Dell J, Winthrop KL, Beukelman T et al: 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res 2012, 64(5):625-639.
71. NICE clinical guideline 79—Rheumatoid arthritis. http://guidance.nice.org.uk/CG79/Guidance/pdf/English accessed Oct 2012.
72. Kiely PD, Deighton C, Dixey J, Ostor AJ, British Society for Rheumatology Standards GAWG: Biologic agents for rheumatoid arthritis--negotiating the NICE technology appraisals. Rheumatology 2012, 51(1):24-31.
73. Sokka T, Envalds M, Pincus T: Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Modern rheumatology / the Japan Rheumatism Association 2008, 18(3):228-239.
74. Bonafede MM, Fox KM, Johnson BH, Watson C, Gandra SR: Factors associated with the initiation of disease-modifying antirheumatic drugs in newly diagnosed rheumatoid arthritis: a retrospective claims database study. Clinical therapeutics 2012, 34(2):457-467.
75. Grijalva CG, Chung CP, Stein CM, Mitchel EF, Jr., Griffin MR: Changing patterns of medication use in patients with rheumatoid arthritis in a Medicaid population. Rheumatology (Oxford) 2008, 47(7):1061-1064.
76. Ziegler S, Huscher D, Karberg K, Krause A, Wassenberg S, Zink A: Trends in treatment and outcomes of rheumatoid arthritis in Germany 1997-2007: results from the National Database of the German Collaborative Arthritis Centres. Annals of the rheumatic diseases 2010, 69(10):1803-1808.
77. Carli C, Ehlin AG, Klareskog L, Lindblad S, Montgomery SM: Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics. Annals of the rheumatic diseases 2006, 65(8):1102-1105.
78. Rantalaiho V, Kautiainen H, Virta L, Korpela M, Mottonen T, Puolakka K: Trends in treatment strategies and the usage of different disease-modifying anti-rheumatic drugs in early rheumatoid arthritis in Finland. Results from a nationwide register in 2000-2007. Scandinavian journal of rheumatology 2011, 40(1):16-21.
79. Edwards CJ, Campbell J, van Staa T, Arden NK: Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study. BMJ Open 2012, 2(6):e001603.
80. Nikolaisen C, Kvien TK, Mikkelsen K, Kaufmann C, Rodevand E, Nossent JC: Contemporary use of disease-modifying drugs in the management of patients with early rheumatoid arthritis in Norway. Scandinavian journal of rheumatology 2009, 38(4):240-245.
81. Yazici Y, Shi N, John A: Utilization of Biologic Agents in Rheumatoid Arthritis in the United States. Bulletin of the NYU Hospital for Joint Diseases 2008, 66(2):77-85.
82. Hyrich KL, Watson KD, Lunt M, Symmons DP: Changes in disease characteristics and response rates among patients in the United Kingdom starting anti-tumour necrosis factor therapy for rheumatoid arthritis between 2001 and 2008. Rheumatology 2011, 50(1):117-123.
83. Lee SJ, Chang H, Yazici Y, Greenberg JD, Kremer JM, Kavanaugh A: Utilization trends of tumor necrosis factor inhibitors among patients with rheumatoid arthritis in a United States observational cohort study. The Journal of rheumatology 2009, 36(8):1611-1617.
84. Liao CH, Wang YC, Chen JJ, Pwu RF: Real-World Utilization Pattern of Biologics in Rheumatoid Arthritis: A Population-Based Study. Value in Health 2012, 15(7):A613-A613.
85. Grijalva CG, Chung CP, Stein CM, Mitchel EF, Jr., Griffin MR: Changing patterns of medication use in patients with rheumatoid arthritis in a Medicaid population. Rheumatology 2008, 47(7):1061-1064.
86. 國家衛生研究院全民健康保險研究資料庫:各檔案間串檔變項說明. http://nhird.nhri.org.tw/date_02.htm accessed Dec 13, 2012.
87. 全民健康保險重大傷病範圍 http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&webdata_id=3471&WD_ID=903 accessed Dec 13,2012.
88. "The International Classification of Diseases, 9th Revision, Clinical Modification" (ICD-9-CM) http://icd9cm.chrisendres.com/ accessed Dec 13,2012.
89. 高雅慧, 鄭靜蘭, : 健保給付藥品品項的藥品藥理治療分類代碼之建立,100 年度委託科技研究計畫期末報告. 2011.
90. Benhamou M, Rincheval N, Roy C, Foltz V, Rozenberg S, Sibilia J, Schaeverbeke T, Bourgeois P, Ravaud P, Fautrel B: The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort. The Journal of rheumatology 2009, 36(5):934-942.
91. Aletaha D, Eberl G, Nell VPK, Machold KP, Smolen JS: Practical progress in realisation of early diagnosis and treatment of patients with suspected rheumatoid arthritis: results from two matched questionnaires within three years. Annals of the rheumatic diseases 2002, 61(7):630-634.
92. Aletaha D, Eberl G, Nell VP, Machold KP, Smolen JS: Attitudes to early rheumatoid arthritis: changing patterns. Results of a survey. Annals of the rheumatic diseases 2004, 63(10):1269-1275.
93. Kim SY, Servi A, Polinski JM, Mogun H, Weinblatt ME, Katz JN, Solomon DH: Validation of rheumatoid arthritis diagnoses in health care utilization data. Arthritis research & therapy 2011, 13(1):R32.
94. Chen C-H, Yang P-M, Huang G-T, Lee H-S, Sung J-L, Sheu J-C: Estimation of Seroprevalence of Hepatitis B Virus and Hepatitis C Virus in Taiwan from a Large-scale Survey of Free Hepatitis Screening Participants. Journal of the Formosan Medical Association 2007, 106(2):148-155.
95. Widdifield J, Bernatsky S, Paterson JM, Thorne JC, Cividino A, Pope J, Gunraj N, Bombardier C: Quality care in seniors with new-onset rheumatoid arthritis: a Canadian perspective. Arthritis Care Res 2011, 63(1):53-57.
96. Schmajuk G, Schneeweiss S, Katz JN, Weinblatt ME, Setoguchi S, Avorn J, Levin R, Solomon DH: Treatment of older adult patients diagnosed with rheumatoid arthritis: improved but not optimal. Arthritis and rheumatism 2007, 57(6):928-934.
97. Schmajuk G, Trivedi AN, Solomon DH, Yelin E, Trupin L, Chakravarty EF, Yazdany J: Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans. JAMA 2011, 305(5):480-486.
98. Garneau KL, Iversen MD, Tsao H, Solomon DH: Primary care physicians' perspectives towards managing rheumatoid arthritis: room for improvement. Arthritis research & therapy 2011, 13(6):R189.
99. Wise EM, Isaacs JD: Management of rheumatoid arthritis in primary care--an educational need? Rheumatology (Oxford) 2005, 44(11):1337-1338.
100. Graudal N, Jurgens G: Similar effects of disease-modifying antirheumatic drugs, glucocorticoids, and biologic agents on radiographic progression in rheumatoid arthritis: meta-analysis of 70 randomized placebo-controlled or drug-controlled studies, including 112 comparisons. Arthritis and rheumatism 2010, 62(10):2852-2863.
101. O'Dell JR HC, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, Garwood V, Maloley P, Klassen LW, Wees S, Klein H, Moore GF.: Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a Combination of All Three Medications. The New England Journal of Medicine 1996, 334(20):1287-1291.
102. Möttönen T, Hannonen P, Leirisalo-Repo M, Nissilä M, Kautiainen H, Korpela M, Laasonen L, Julkunen H, Luukkainen R, Vuori K et al: Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. The Lancet 1999, 353(9164):1568-1573.
103. Ogasawara M, Kageyama M, Kusaoi M, Onuma S, Kon T, Sekiya F, Sugimoto K, Matsudaira R, Matsushita M, Tada K et al: Recent trends in use of nonbiologic DMARDs and evaluation of their continuation rates in single and dual combination therapies in rheumatoid arthritis patients in Japan. Modern rheumatology / the Japan Rheumatism Association 2012, 22(6):831-836.
104. Sokka T, Pincus T: Ascendancy of weekly low-dose methotrexate in usual care of rheumatoid arthritis from 1980 to 2004 at two sites in Finland and the United States. Rheumatology 2008, 47(10):1543-1547.
105. Grijalva CG, Chung CP, Arbogast PG, Stein CM, Mitchel EF, Jr., Griffin MR: Assessment of adherence to and persistence on disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis. Med Care 2007, 45(10 Supl 2):S66-76.
106. Rantalaiho V, Puolakka K, Korpela M, Hannonen P, Möttönen T: Long-term results of the FIN-RACo trial; treatment with a combination of traditional disease-modifying anti rheumatic drugs is an excellent option in early rheumatoid arthritis. Clin Exp Rheumatol 2012, 30:S27-S31.
107. Soliman MM, Ashcroft DM, Watson KD, Lunt M, Symmons DP, Hyrich KL, British Society for Rheumatology Biologics R: Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Annals of the rheumatic diseases 2011, 70(4):583-589.
108. Prince FH, Bykerk VP, Shadick NA, Lu B, Cui J, Frits M, Iannaccone CK, Weinblatt ME, Solomon DH: Sustained rheumatoid arthritis remission is uncommon in clinical practice. Arthritis research & therapy 2012, 14(2):R68.
109. O'Mahony R, Richards A, Deighton C, Scott D: Withdrawal of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis. Annals of the rheumatic diseases 2010, 69(10):1823-1826.
110. van den Bemt BJ ZH, van den Ende CH: Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol 2012, 8(4):337-351.
111. Contreras-Yanez I, De Leon SP, Cabiedes J, Rull-Gabayet M, Pascual-Ramos V: Inadequate Therapy Behavior Is Associated to Disease Flares in Patients With Rheumatoid Arthritis Who Have Achieved Remission With Disease-Modifying Antirheumatic Drugs. Am J Med Sci 2010, 340(4):282-290.
112. Pascual-Ramos V, Contreras-Yanez I, Villa AR, Cabiedes J, Rull-Gabayet M: Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability. Arthritis research & therapy 2009, 11(1):R26.
113. Salt E, Frazier SK: Predictors of Medication Adherence in Patients with Rheumatoid Arthritis. Drug development research 2011, 72(8):756-763.
114. 99年全民健康保險統計/84年到99年趨勢統計http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1023&WD_ID=1023&webdata_id=4004 accessed Dec 13,2012.
115. 內政統計通報-99年底人口結構分析http://sowf.moi.gov.tw/stat/week/list.htm accessed Dec 13,2012.
116. 全民健保特約醫事服務機構家數統計表-100年度 1月http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1023&WD_ID=1023&webdata_id=3797 accessed Dec 13,2012.
117. Neame R, Hammond A: Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology 2005, 44(6):762-767.
118. Salt E, Hall L, Peden AR, Home R: Psychometric properties of three medication adherence scales in patients with rheumatoid arthritis. Journal of nursing measurement 2012, 20(1):59-72.
119. 成大藥劑部 http://140.116.253.135/NewHomePage/index.asp accessed Aug 1,2012.
120. van den Bemt BJ, van den Hoogen FH, Benraad B, Hekster YA, van Riel PL, van Lankveld W: Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs. The Journal of rheumatology 2009, 36(10):2164-2170.
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