PMID- 29980576
OWN - NLM
STAT- MEDLINE
DCOM- 20190819
LR  - 20191210
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Linking)
VI  - 77
IP  - 10
DP  - 2018 Oct
TI  - Inequity in access to bDMARD care and how it influences disease outcomes across 
      countries worldwide: results from the METEOR-registry.
PG  - 1413-1420
LID - 10.1136/annrheumdis-2018-213289 [doi]
AB  - OBJECTIVE: To establish in a global setting the relationships between countries' 
      socioeconomic status (SES), measured biological disease modifying antirheumatic 
      drug (bDMARD)-usage and disease outcomes. To assess if prescription and 
      reimbursement rules and generic access to medication relates to a countries' 
      bDMARD-usage. METHODS: Data on disease activity and drug use from countries that 
      had contributed at least 100 patients were extracted from the METEOR database. 
      Mean disease outcomes of all available patients at the final visit were 
      calculated on a per-country basis. A questionnaire was sent to at least two 
      rheumatologists per country inquiring about DMARD-prices, access to treatment and 
      valid regulations for prescription and reimbursement. RESULTS: Data from 20 379 
      patients living in 12 different countries showed that countries' SES was 
      positively associated with measured disease activity (meanDAS28), but not always 
      with physical functioning (HAQ-score). A lower country's SES, stricter rules for 
      prescription and reimbursement of bDMARDs as well as worse affordability of 
      bDMARDs were associated with lower bDMARD-usage. bDMARD-usage was negatively 
      associated with disease activity (although not with physical functioning), but 
      the association was moderate at best. CONCLUSIONS: Disease activity in patients 
      with rheumatoid arthritis as well as bDMARD-usage varies across countries 
      worldwide. The (negative) relationship between countries' bDMARD-usage and level 
      of disease activity is complex and under the influence of many factors, 
      including-but not limited to-countries' SES, affordability of bDMARDs and valid 
      prescription and reimbursement rules for bDMARDs.
CI  - (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Bergstra, Sytske Anne
AU  - Bergstra SA
AUID- ORCID: 0000-0002-7136-5248
AD  - Department of Rheumatology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Branco, Jaime C
AU  - Branco JC
AD  - Department of Rheumatology, CEDOC, Faculdade de Ciencias Medicas, Universidade 
      Nova de Lisboa, Lisbon, Portugal.
AD  - CHLO, EPE-Hospital Egas Moniz, Lisbon, Portugal.
FAU - Vega-Morales, David
AU  - Vega-Morales D
AUID- ORCID: 0000-0003-0651-2202
AD  - Department of Rheumatology, Universidad Autonoma de Nuevo Leon, San Nicolas de 
      los Garza, Mexico.
FAU - Salomon-Escoto, Karen
AU  - Salomon-Escoto K
AD  - Rheumatology Center, UMass Memorial Medical Center, University of Massachusetts 
      Medical School, Worcester, Massachusetts, USA.
FAU - Govind, Nimmisha
AU  - Govind N
AD  - Department of Rheumatology, University of the Witwatersrand, Johannesburg, South 
      Africa.
FAU - Allaart, Cornelia F
AU  - Allaart CF
AD  - Department of Rheumatology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Landewe, Robert B M
AU  - Landewe RBM
AD  - Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
AD  - Zuyderland Medical Center, Heerlen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20180706
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 0 (Antirheumatic Agents)
MH  - Adult
MH  - Aged
MH  - Antirheumatic Agents/*therapeutic use
MH  - Female
MH  - Global Health/*statistics & numerical data
MH  - Health Services Accessibility/*statistics & numerical data
MH  - Healthcare Disparities/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care
MH  - Registries
MH  - Rheumatic Diseases/*drug therapy/epidemiology
MH  - Surveys and Questionnaires
OTO - NOTNLM
OT  - DMARDs (biologic)
OT  - disease activity
OT  - economic evaluations
OT  - rheumatoid arthritis
COIS- Competing interests: None declared.
EDAT- 2018/07/08 06:00
MHDA- 2019/08/20 06:00
CRDT- 2018/07/08 06:00
PHST- 2018/02/22 00:00 [received]
PHST- 2018/06/18 00:00 [revised]
PHST- 2018/06/19 00:00 [accepted]
PHST- 2018/07/08 06:00 [pubmed]
PHST- 2019/08/20 06:00 [medline]
PHST- 2018/07/08 06:00 [entrez]
AID - annrheumdis-2018-213289 [pii]
AID - 10.1136/annrheumdis-2018-213289 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2018 Oct;77(10):1413-1420. doi: 10.1136/annrheumdis-2018-213289. 
      Epub 2018 Jul 6.