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Inconsistent treatment with disease-modifying antirheumatic drugs: a longitudinal data analysis

Maria D Mjaavatten¹, Helga Radner², Kazuki Yoshida²

¹From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital. maria_mjaavatten@hotmail.com.

The Journal of Rheumatology

|October 17, 2014

Summary

A small percentage of rheumatoid arthritis patients inconsistently used disease-modifying antirheumatic drugs (DMARDs). Reasons included inactive disease and intolerance, though many later became consistent users.

Area of Science:

Rheumatology
Clinical Immunology
Pharmacoepidemiology

Background:

Current guidelines recommend disease-modifying antirheumatic drugs (DMARDs) for all active rheumatoid arthritis (RA) patients.
Understanding patterns of DMARD use is crucial for optimizing RA management.

Purpose of the Study:

To determine the frequency and reasons for inconsistent DMARD use in a clinical RA cohort.
To identify patient characteristics associated with inconsistent DMARD utilization.

Main Methods:

Analysis of DMARD use (any or none) at semiannual timepoints over 2 years in the Brigham Rheumatoid Arthritis Sequential Study cohort.
Definition of inconsistent use as DMARD use at ≤40% of study timepoints.
Multivariate logistic regression and medical record review to identify correlates and reasons for inconsistent use.

Main Results:

6.5% of patients (55/848) exhibited inconsistent DMARD use.
Inconsistent use correlated with higher age, longer disease duration, and rheumatoid factor negativity.
Primary reasons for inconsistency included inactive disease (50.9%), DMARD intolerance (32.7%), and patient preference (12.7%).

Conclusions:

A minority of RA patients demonstrate inconsistent DMARD use early in their disease course.
Patient-specific factors influence DMARD adherence.
A significant proportion of initially inconsistent users transition to consistent DMARD use over time.

Keywords:

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS DRUG ADHERENCE LONGITUDINAL STUDIES RHEUMATOID ARTHRITIS

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