Journal List > J Rheum Dis > v.21(2) > 1064164

J Rheum Dis. 2014 Apr;21(2):64-73. Korean.
Published online April 30, 2014.
Copyright © 2014 by The Korean College of Rheumatology
Prediction for TNF Inhibitor Users in RA Patients According to Reimbursement Criteria Based on DAS28
Soyoung Won,1 Yoon-Kyoung Sung,1,2 Soo-Kyung Cho,1,2 Chan-Bum Choi,1,2 Eun-Mi Koh,3 Seong-Kyu Kim,4 Jinseok Kim,5 Tae-Hwan Kim,2 Hyoun Ah Kim,6 Seong-Su Nah,7 So-Young Bang,8 Chang-Hee Suh,6 Seung Cheol Shim,9 Dae-Hyun Yoo,2 Bo Young Yoon,10 Sang-Hoon Lee,11 Sung Won Lee,12 Shin-Seok Lee,13 Yeon-Ah Lee,14 Jaejoon Lee,3 Jisoo Lee,15 Hye-Soon Lee,8 Mi Kyoung Lim,16 Jae-Bum Jun,2 Chan Hong Jeon,17 Young Ok Jung,18 Won Tae Chung,12 Hoon-Suk Cha,3 Jung-Yoon Choe,4 Seung-Jae Hong,14 and Sang-Cheol Bae1,2
1Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea.
2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
3Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
4Department of Rheumatology, Catholic University of Daegu, School of Medicine, Daegu, Korea.
5Department of Rheumatology, Jeju National University Hospital, Jeju, Korea.
6Department of Rheumatology, Ajou University Hospital, Suwon, Korea.
7Department of Rheumatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
8Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea.
9Department of Rheumatology, Chungnam National University Hospital, Daejeon, Korea.
10Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea.
11Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
12Department of Rheumatology, Dong-A University Hospital, Busan, Korea.
13Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea.
14Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea.
15Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
16Department of Rheumatology, Eulji University Hospital, Daejeon, Korea.
17Department of Rheumatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
18Department of Rheumatology, Hallym University College of Medicine, Seoul, Korea.

Corresponding to: Sang-Cheol Bae, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 133-792, Korea. Email:
Received January 10, 2014; Revised March 26, 2014; Accepted March 27, 2014.

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.



The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria.


Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement.


Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP).


Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.

Keywords: Korean National Health Insurance reimbursement criteria; Rheumatoid arthritis; TNF inhibitor; DAS28

Supplementary Materials
Supplementary Table 1

Baseline characteristics in RA patients using the criteria with DAS28-ESR

Click here to view.(48K, pdf)
Supplementary Table 2

Baseline characteristics in RA patients using the criteria with DAS28-CRP

Click here to view.(47K, pdf)


Figure 1
Derivation of samples for study.
Click for larger image


Table 1
Baseline characteristics in RA patients using TNF inhibitor for 3 months
Click for larger image

Table 2
Eligibility with the new criteria of RA patients starting TNF inhibitor satisfied with the past initiation criteria (n=299)
Click for larger image

Table 3
Distribution change by the maintenance criteria after 3 months in RA patients using TNF inhibitor among patients satisfied with new the initiation criteria
Click for larger image

Table 4
Comparing criteria for eligibility and maintenance of treatment with biological DMARDs in 10 countries
Click for larger image

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