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Patterns of drug use in rheumatoid arthritis
A Bérard1, D H Solomon, J Avorn
1Brigham and Womenś Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics, and Harvard Medical School, Boston, MA 02115, USA.
Objective:
Treatment strategies for rheumatoid arthritis (RA) are rapidly evolving, but few data exist on current prescribing patterns in distinct populations of patients and physicians. We described patterns of drug use for RA in a large population including use of nonsteroidal antiinflammatory drugs (NSAID), disease modifying antirheumatic drugs (DMARD), and corticosteroids.
Methods:
We identified a cohort of 10,262 New Jersey Medicaid/Medicare/PAAD (Pharmacy Assistance for the Aged and the Disabled) beneficiaries with at least one episode of care for RA between January 1, 1992, and January 1, 1995, and at least one episode of care after December 31, 1995. All patients were present for the entire study period and thus constituted a closed cohort. All filled prescriptions, hospitalizations, nursing home care, and physician visits during 1995 were analyzed.
Results:
The cohort was 67 years old on average, 82% female, and 63% white; 63% were enrolled in Medicaid and 9% were in a nursing home at the beginning of followup. During the study year, 68% of patients filled at least one prescription for any of the drug groups studied. The most frequently prescribed medication was an NSAID (57%), followed by corticosteroids (23%) and DMARD (13%). Thirty-nine percent of patients used only NSAID, 2% only DMARD, and 6% only corticosteroid. Patients taking NSAID used them on average for 3 months during the study year, corticosteroids for 4 months, and DMARD for over 7 months. During the study year, one-third of DMARD users stopped all DMARD therapy. One-third of prednisone users were taking doses higher than 10 mg/day.
Conclusion:
While our RA cohort was older than would be expected, they represent a typical Medicare and Medicaid or PAAD population. In this cohort of patients with a diagnosis of RA cared for by either general practitioners or rheumatologists, NSAID were the most commonly prescribed medication, with substantially lower rates of use for DMARD and corticosteroids. Drug discontinuation and medication switching were common.