Research On Innovative Medication Management Service Model For Patients With Rheumatic Immune Diseases

Objective: To explore the improvement of drug-related problems in outpatients with Ankylosing Spondylitis(AS)and Rheumatoid Arthritis(RA)after receiving medication management services.At the same time,the potential and serious risk signals of biological disease-modifying antirheumatic drugs(DMARDs)were detected to provide theoretical basis for the prevention of ADE.Methods: First of all,the personal files of AS and RA patients in Sichuan Provincial People’s hospital were established.According to the examination indexes and symptoms of patients at the initial visit,the problems of drug treatment in terms of indications,safety,effectiveness and compliance were evaluated the Chinese version of compliance-rheumatology.Regression model was used to analyze the influencing factors of patients’ compliance.From October 2019 to October 2020,pharmaceutical intervention measures and patient education were given to patients.One year later,the changes of effectiveness,safety and compliance between the last follow-up and the first patient evaluation were compared.On the other hand,the data of FAERS database from September 2012 to April 2020 were downloaded.Med DRA software was used for organ/ system classification and Sinicization.The signal detection of 5 biological DMARDs was carried out by reporting ratio ratio method.The signal detection results were compared with the ADE and DME lists found in the clinical follow-up observation,and the potential and serious risk signals were detected respectively.Results: Among 103 RA patients and 112 AS patients included in this study,the most frequently used biological DMARDs were tocilizumab and etanercept.Methotrexate was the most common drug in RA patients,which the utilization rate was59.2%.The types of combined drugs in AS patients were mainly NASIDs,with the utilization rate of 15.2%.A total of 103 patients with RA and 112 patients with AS were enrolled in this study.The most commonly used biological DMARDs were etanercept.After one year of medication management services,the number of drug-related problems of patients with rheumatic immune diseases decreased from 424 to 97,from1.97 to 0.45 per person.The mean value of blood sedimentation rate and C-reactive protein index decreased significantly.The number of safety problems decreased from111 to 29,and the reduction rate of adverse reactions was 73.87%.The proportion of patients with rheumatoid arthritis and good compliance with ankylosing spondylitis increased from 29.13% to 85.44% and from 28.57% to 80.36%,respectively.The improvement rate of clinical outcome was 66.22% and 63.01%,respectively.In the FAERS database,a total of 61 risk signals were detected in ADEs detected during follow-up,of which 8 risk signals were not recorded in the specification.The 26 severe ADE signals detected mainly involved liver,gallbladder,ear,eye,lung,pancreas and other organs,and the least severe ADE signals were found in etanercept.Conclusion: This study establishes an innovative medication management service model for patients with rheumatic immune diseases,which have solved the problem of drug-related problems and brought high clinical value.The potential and serious risk signals found in this study provide a theoretical basis for the establishment of safety monitoring points for biological DMARDs.The potential and serious risk signals found in this study provide a theoretical basis for the establishment of safety monitoring points of biological DMARDs.