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Disappointing longterm results with disease modifying antirheumatic drugs. A practice based study
G Galindo-Rodriguez1, J A Aviña-Zubieta, A S Russell
1Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
The Journal of Rheumatology
|November 11, 1999
Summary
Disease-modifying antirheumatic drugs (DMARDs) show short-term effectiveness in rheumatoid arthritis (RA) patients. Methotrexate (MTX) offers better continuation rates within the first five years compared to other DMARDs.
Area of Science:
- Rheumatology
- Clinical Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease requiring long-term management.
- Disease-modifying antirheumatic drugs (DMARDs) are cornerstone therapies for RA.
- Understanding DMARD discontinuation rates is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the long-term effectiveness and discontinuation rates of DMARDs in an inception cohort of RA patients.
- To compare the continuation probabilities of various DMARDs over time.
Main Methods:
- Retrospective audit of 2296 DMARD therapies in RA patients diagnosed between 1985 and 1994.
- Survival analysis using Kaplan-Meier and Cox proportional hazard regression.
- Analysis of drug discontinuation and toxicity over time.
Main Results:
- 50% of DMARD therapies were discontinued by 16 months; 75% by 4.5 years.
- Methotrexate (MTX) demonstrated the highest continuation probability, with 50% of patients still on MTX after 3 years.
- Toxicity from gold compounds occurred early, while MTX withdrawals due to toxicity persisted throughout therapy.
Conclusions:
- DMARDs in RA patients exhibit short therapeutic durations, even with early treatment.
- MTX appears to be the most effective DMARD in the initial 5 years of RA treatment.
- Long-term differences in effectiveness between DMARDs diminish over time, and the impact of early MTX benefits on long-term health status remains unclear.