Temporal relationship between idiopathic inflammatory myopathies and malignancies and its mortality: a nationwide population-based study.

OBJECTIVES: To examine the temporal relationship between malignancies and idiopathic inflammatory myopathies (IIMs) and its impact on mortality. METHODS: A retrospective cohort for IIM patients was conducted using the Korean National Health Insurance Service databases. We observed more than 5 years before and after the diagnosis of IIM (2002~2016) to identify IIM patients who developed any malignancy and classified these patients into two groups: the cancer-associated myositis (CAM) group, who developed malignancy within 3 years before or after the diagnosis of IIM and the cancer-not-associated myositis (CNAM) group, who developed malignancy beyond 3 years of IIM onset. The survival rates of the two groups were compared. RESULTS: We identified 1072 incident cases of IIM between 2007 and 2011. A total 225 patients of these patients were diagnosed with malignancy. The development of malignancy was frequent within 1 year before and after the time of IIM diagnosis. The common sites of malignancies in the CAM group differed from those in the CNAM group: the lung, hematologic malignancy, and the liver were common in both groups, but thyroid and oropharynx followed them in CAM while prostate, stomach, breast, and thyroid followed them in CNAM. CAM patient mortality was worse compared with CNAM patients (log-rank test, p < 0.01). CONCLUSIONS: Among IIM patients with malignancy, common sites of malignancy were different between the CAM and CNAM groups, and patients with CAM had poor prognosis compared with CNAM patients. Key Points • The malignancies commonly occurred in incident idiopathic inflammatory myopathy (IIM) patients, especially within 1 year before and after the initial IIM diagnosis. • Patients with malignancy had poor survival compared with patients without malignancy. • Among the IIM patients with malignancy, patients who developed malignancy within 3 years of IIM diagnosis (cancer-associated myositis, or CAM, group) showed higher mortality than cancer-not-associated myositis, CNAM group. • We also found that the common types of malignancy were different between the CAM and CNAM groups.

Factors for starting biosimilar TNF inhibitors in patients with rheumatic diseases in the real world.

BACKGROUND: To identify factors for starting biosimilar TNF inhibitors (TNFI) in patients with rheumatic diseases. METHODS AND FINDING: Using a national claims database, we identified patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) who had used TNFIs since they were approved in Korea in 2004. We assessed changes in the proportion of each form of TNFI used between 2004 and 2017. We then selected patients starting on TNFIs between 2013 and 2017 to identify factors for starting biosimilars. In RA (n = 4,216), biosimilars were more likely to be initiated in clinics [odds ratio (OR) 2.54] and in the metropolitan area (OR, 2.02), but were less likely to be initiated in general hospitals (OR 0.40) or orthopedics (OR 0.44). In AS (n = 2,338), biosimilars were common at the hospital level (OR 2.20) and tended to increase over the years (OR 1.16), but were initiated less in orthopedics (OR 0.07). In addition, RA patients were more likely to initiate biosimilars in combination with methotrexate (OR 1.37), but biosimilars were not initiated frequently by patients with higher comorbidity scores (OR 0.97) or receiving glucocorticoids (OR 0.67). The patient factors favoring biosimilar in AS use were not clear. CONCLUSIONS: In Korea, the proportion of biosimilar TNFIs has increased. Type of institution and physician specialty are more important than patient factors in affecting biosimilar use. In RA, biosimilar TNFIs tend to be initiated in combination with MTX, and are less likely to be initiated in patients taking glucocorticoids or in those with high comorbidities.

Increased risk of malignancy in patients aged over 50 with idiopathic inflammatory myositis compared to patients with osteoarthritis of the knee.

Objectives: To estimate risk of malignancy in patients with idiopathic inflammatory myositis (IIM) compared to patients with knee osteoarthritis (OA).Methods: Patients with IIM and knee OA aged over 50, who had no history of malignancy, were identified using Korean National claims database from January 2012 to December 2014. They had been observed until a malignancy was diagnosed or up to the end of the study, December 2015. The incidence rate (IR) of malignancy in IIM patients was calculated and compared with knee OA patients using standardized incidence ratio (SIR).Results: A total of 634 polymyositis (PM) and 556 dermatomyositis (DM) patients were included. Overall, 100 solid (IR 270.4/10,000 person-years (PY), 95% confidence interval (CI) 217.4-323.4) and 12 hematologic malignancies (IR 32.4/10,000 PY, 95% CI 14.1-50.8) occurred. Compared with knee OA, risk of overall (SIR 1.5, 95% CI 1.2-1.8), solid (SIR 1.4, 95% CI 1.1-1.6), and hematologic malignancy (SIR 5.7, 95% CI 2.5-9.0) were increased in IIM patients. This was due to increased incidence of malignancy in DM (hematologic malignancy, SIR 8.7, 95% CI 2.7-14.7, solid malignancy, SIR 1.5, 95% CI 1.1-1.9).Conclusion: Patients with IIM, especially DM, have an increased risk of malignancy compared to patients with knee OA.

A Real-World Analysis of Prescribing Patterns and Non-persistence of Anti-TNFα Therapy for Inflammatory Bowel Disease.

BACKGROUND AND OBJECTIVES: Anti-tumor necrosis factor alpha (anti-TNFα) therapy is key to the treatment of inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD). The objective of this study was to investigate prescribing patterns and non-persistence of anti-TNFα therapy for the treatment of IBD in a real-world scenario. METHODS: Data from the Korean National Health Insurance claims database obtained between 2010 and 2014 were evaluated to identify patients with IBD who had received anti-TNFα therapy (infliximab or adalimumab). Patient characteristics and prescribing patterns were investigated. The non-persistence rate and associated reasons were determined in patients who initiated therapy between 2010 and 2012. RESULTS: A total of 131,158 patients with UC and 57,286 with CD were identified. Of these 1747 UC (1.3%) and 3731 (6.5%) CD patients had received anti-TNFα therapy and were included in the analysis. Infliximab was prescribed more frequently than adalimumab (84.6% vs 15.4% in UC and 80.7% vs 19.4% in CD); 81.0% of UC and 72.0% of CD patients received anti-TNFα alone or in combination with 5-aminosalicylic acid. The non-persistence rate of anti-TNFα therapy was 72.6% and 80.4% in the UC and CD groups, respectively, with discontinuation of medication being the most common reason in both the UC and CD groups (63.9% and 73.3%, respectively). CONCLUSION: The use of anti-TNFα therapy was seen to be low, with a high rate of non-persistence. Further research efforts are required to improve the response rate and, therefore, improve persistence in patients with IBD.