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Treatment with tumor necrosis factor inhibitors in axial spondyloarthritis: comparison between private rheumatology practices and academic centers in a large observational cohort.
J Rheumatol. 2015 Jan; 42(1):101-5.JR

Abstract

OBJECTIVE

To evaluate the initiation of and response to tumor necrosis factor (TNF) inhibitors for axial spondyloarthritis (axSpA) in private rheumatology practices versus academic centers.

METHODS

We compared newly initiated TNF inhibition for axSpA in 363 patients enrolled in private practices with 100 patients recruited in 6 university hospitals within the Swiss Clinical Quality Management (SCQM) cohort.

RESULTS

All patients had been treated with ≥ 1 nonsteroidal antiinflammatory drug and > 70% of patients had a baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4 before anti-TNF agent initiation. The proportion of patients with nonradiographic axSpA (nr-axSpA) treated with TNF inhibitors was higher in hospitals versus private practices (30.4% vs 18.7%, p = 0.02). The burden of disease as assessed by patient-reported outcomes at baseline was slightly higher in the hospital setting. Mean levels (± SD) of the Ankylosing Spondylitis Disease Activity Score were, however, virtually identical in private practices and academic centers (3.4 ± 1.0 vs 3.4 ± 0.9, p = 0.68). An Assessment of SpondyloArthritis international Society (ASAS40) response at 1 year was reached for ankylosing spondylitis in 51.7% in private practices and 52.9% in university hospitals (p = 1.0) and for nr-axSpA in 27.5% versus 25.0%, respectively (p = 1.0).

CONCLUSION

With the exception of a lower proportion of patients with nr-axSpA newly treated with anti-TNF agents in private practices in comparison to academic centers, adherence to ASAS treatment recommendations for TNF inhibition was equally high, and similar response rates to TNF blockers were achieved in both clinical settings.

Authors+Show Affiliations

From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel. adrian.ciurea@usz.ch.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25362654

Citation

Ciurea, Adrian, et al. "Treatment With Tumor Necrosis Factor Inhibitors in Axial Spondyloarthritis: Comparison Between Private Rheumatology Practices and Academic Centers in a Large Observational Cohort." The Journal of Rheumatology, vol. 42, no. 1, 2015, pp. 101-5.
Ciurea A, Weber U, Stekhoven D, et al. Treatment with tumor necrosis factor inhibitors in axial spondyloarthritis: comparison between private rheumatology practices and academic centers in a large observational cohort. J Rheumatol. 2015;42(1):101-5.
Ciurea, A., Weber, U., Stekhoven, D., Scherer, A., Tamborrini, G., Bernhard, J., Toniolo, M., Villiger, P. M., Zufferey, P., Kissling, R. O., Michel, B. A., & Exer, P. (2015). Treatment with tumor necrosis factor inhibitors in axial spondyloarthritis: comparison between private rheumatology practices and academic centers in a large observational cohort. The Journal of Rheumatology, 42(1), 101-5. https://doi.org/10.3899/jrheum.140229
Ciurea A, et al. Treatment With Tumor Necrosis Factor Inhibitors in Axial Spondyloarthritis: Comparison Between Private Rheumatology Practices and Academic Centers in a Large Observational Cohort. J Rheumatol. 2015;42(1):101-5. PubMed PMID: 25362654.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment with tumor necrosis factor inhibitors in axial spondyloarthritis: comparison between private rheumatology practices and academic centers in a large observational cohort. AU - Ciurea,Adrian, AU - Weber,Ulrich, AU - Stekhoven,Daniel, AU - Scherer,Almut, AU - Tamborrini,Giorgio, AU - Bernhard,Jürg, AU - Toniolo,Martin, AU - Villiger,Peter M, AU - Zufferey,Pascal, AU - Kissling,Rudolf O, AU - Michel,Beat A, AU - Exer,Pascale, AU - ,, Y1 - 2014/11/01/ PY - 2014/11/3/entrez PY - 2014/11/5/pubmed PY - 2015/11/6/medline KW - AXIAL SPONDYLOARTHRITIS KW - TREATMENT RESPONSE KW - TUMOR NECROSIS FACTOR INHIBITORS SP - 101 EP - 5 JF - The Journal of rheumatology JO - J. Rheumatol. VL - 42 IS - 1 N2 - OBJECTIVE: To evaluate the initiation of and response to tumor necrosis factor (TNF) inhibitors for axial spondyloarthritis (axSpA) in private rheumatology practices versus academic centers. METHODS: We compared newly initiated TNF inhibition for axSpA in 363 patients enrolled in private practices with 100 patients recruited in 6 university hospitals within the Swiss Clinical Quality Management (SCQM) cohort. RESULTS: All patients had been treated with ≥ 1 nonsteroidal antiinflammatory drug and > 70% of patients had a baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4 before anti-TNF agent initiation. The proportion of patients with nonradiographic axSpA (nr-axSpA) treated with TNF inhibitors was higher in hospitals versus private practices (30.4% vs 18.7%, p = 0.02). The burden of disease as assessed by patient-reported outcomes at baseline was slightly higher in the hospital setting. Mean levels (± SD) of the Ankylosing Spondylitis Disease Activity Score were, however, virtually identical in private practices and academic centers (3.4 ± 1.0 vs 3.4 ± 0.9, p = 0.68). An Assessment of SpondyloArthritis international Society (ASAS40) response at 1 year was reached for ankylosing spondylitis in 51.7% in private practices and 52.9% in university hospitals (p = 1.0) and for nr-axSpA in 27.5% versus 25.0%, respectively (p = 1.0). CONCLUSION: With the exception of a lower proportion of patients with nr-axSpA newly treated with anti-TNF agents in private practices in comparison to academic centers, adherence to ASAS treatment recommendations for TNF inhibition was equally high, and similar response rates to TNF blockers were achieved in both clinical settings. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/25362654/Treatment_with_tumor_necrosis_factor_inhibitors_in_axial_spondyloarthritis:_comparison_between_private_rheumatology_practices_and_academic_centers_in_a_large_observational_cohort_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=25362654 DB - PRIME DP - Unbound Medicine ER -