Validation of new medication use algorithms as proxies for worsening disease activity in patients with juvenile idiopathic arthritis

TY - JOUR

T1 - Validation of new medication use algorithms as proxies for worsening disease activity in patients with juvenile idiopathic arthritis

AU - Saito, Kyoko

AU - Gabbeta, Avinash

AU - Mulvihill, Evan

AU - Al-Jaberi, Lina

AU - Beukelman, Timothy

AU - Lewis, James D.

AU - Rose, Carlos D.

AU - Strom, Brian L.

AU - Horton, Daniel B.

N1 - Publisher Copyright: © 2024 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

PY - 2024/5

Y1 - 2024/5

N2 - Purpose: To facilitate claims-based research on populations with juvenile idiopathic arthritis (JIA), we sought to validate an algorithm of new medication use as a proxy for worsening JIA disease activity. Methods: Using electronic health record data from three pediatric centers, we defined new JIA medication use as (re)initiation of disease-modifying antirheumatic drugs or glucocorticoids (oral or intra-articular). Data were collected from 201 randomly selected subjects with (101) or without (100) new medication use. We assessed the positive predictive value (PPV) and negative predictive value (NPV) based on a reference standard of documented worsening of JIA disease activity. The algorithm was refined to optimize test characteristics. Results: Overall, the medication-based algorithm had suboptimal performance in representing worsening JIA disease activity (PPV 69.3%, NPV 77.1%). However, algorithm performance improved for definitions specifying longer times after JIA diagnosis (≥1-year post-diagnosis: PPV 82.9%, NPV 80.0%) or after initiation of prior JIA treatment (≥1-year post-treatment: PPV 89.7%, NPV 80.0%). Conclusion: An algorithm for new JIA medication use appears to be a reasonable proxy for worsening JIA disease activity, particularly when specifying new use ≥1 year since initiating a prior JIA medication. This algorithm will be valuable for conducting research on JIA populations within administrative claims databases.

AB - Purpose: To facilitate claims-based research on populations with juvenile idiopathic arthritis (JIA), we sought to validate an algorithm of new medication use as a proxy for worsening JIA disease activity. Methods: Using electronic health record data from three pediatric centers, we defined new JIA medication use as (re)initiation of disease-modifying antirheumatic drugs or glucocorticoids (oral or intra-articular). Data were collected from 201 randomly selected subjects with (101) or without (100) new medication use. We assessed the positive predictive value (PPV) and negative predictive value (NPV) based on a reference standard of documented worsening of JIA disease activity. The algorithm was refined to optimize test characteristics. Results: Overall, the medication-based algorithm had suboptimal performance in representing worsening JIA disease activity (PPV 69.3%, NPV 77.1%). However, algorithm performance improved for definitions specifying longer times after JIA diagnosis (≥1-year post-diagnosis: PPV 82.9%, NPV 80.0%) or after initiation of prior JIA treatment (≥1-year post-treatment: PPV 89.7%, NPV 80.0%). Conclusion: An algorithm for new JIA medication use appears to be a reasonable proxy for worsening JIA disease activity, particularly when specifying new use ≥1 year since initiating a prior JIA medication. This algorithm will be valuable for conducting research on JIA populations within administrative claims databases.

KW - algorithms

KW - juvenile arthritis

KW - pharmacoepidemiology

KW - routinely collected health data

KW - validation study

UR - http://www.scopus.com/inward/record.url?scp=85191824009&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85191824009&partnerID=8YFLogxK

U2 - 10.1002/pds.5803

DO - 10.1002/pds.5803

M3 - Article

C2 - 38685851

SN - 1053-8569

VL - 33

JO - Pharmacoepidemiology and drug safety

JF - Pharmacoepidemiology and drug safety

IS - 5

M1 - e5803

ER -