Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Real World Utilization of Nonbiologic and Biologic Disease Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis: A Systematic Review of the Literature

Pruhs,  Zachary M., Harrold,  Leslie R.


To date, no systematic review of the literature regarding real world use of disease modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) has been performed. Our goals in undertaking this review include 1) provide a comprehensive summary of published studies on real world utilization of DMARDs in patients with RA and 2) identify gaps in our current knowledge regarding medication use patterns.


Employing the Cochrane Collaboration systematic review guidelines, we conducted a MEDLINE search from January 1, 1989 through March 17, 2009 for English language articles evaluating real world utilization of biologic and non-biologic DMARDs in RA. Search terms included the key words: (rheumatoid arthritis) and (abatacept, or adalimumab, or etanercept, or hydroxychloroquine, or infliximab, or methotrexate, or minocycline, or leflunomide, or rituximab, or sulfasalazine). Articles were then limited to medical subject headings (MeSH) including pharmacoepidemiology or drug utilization or drug therapy.


Our search strategy yielded 1,376 articles, of which 42 articles met inclusion criteria. The included articles were grouped by primary focus into those examining prescribing patterns, persistence, dosing, and adherence. Most articles evaluated prescribing patterns (n=23) and/or medication persistence (n=23). Most studies examining prescribing patterns showed a trend towards earlier and more frequent use of both biologic and non-biologic (particularly methotrexate) DMARDs. However, those studies that focused on patients cared for by primary care providers found lower rates of DMARDs use (range of 13 to 63%). Additionally, very few studies evaluated appropriateness of medication use or the factors influencing use of medications. Studies examining persistence found it was greatest among methotrexate users as compared to other nonbiologic DMARDs. There was conflicting data regarding persistence among the different biologic agents. There were only 6 studies evaluating dosing and all but one were focused on infliximab. Only 3 studies examined adherence, 2 of which found adherence to infliximab superior to methotrexate and etanercept respectively.


Most of the current literature on real world utilization of DMARDs in the management of RA finds earlier and more aggressive use of nonbiologic and biologic agents as well as greater persistence among methotrexate users. Very few studies have examined medication adherence or dosing of DMARDs other than infliximab. Of concern is possible DMARD underutilization based on studies of RA patients cared for by primary care providers. More investigation examining whether there is appropriate use of medications is needed in order to ensure optimal quality of care.

To cite this abstract, please use the following information:
Pruhs, Zachary M., Harrold, Leslie R.; Real World Utilization of Nonbiologic and Biologic Disease Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis: A Systematic Review of the Literature [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1007
DOI: 10.1002/art.26084

Abstract Supplement

Meeting Menu