Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

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


Rheumatologists Prescribing Patterns for Rheumatoid Arthritis Patients with Active Disease

Harrold1,  Leslie R., Greenberg2,  Jeffrey D., Curtis3,  Jeffrey R., Bentley1,  Mary jane, Reed4,  George, Harrington5,  J. Timothy

Univ of Massachusetts Med Schl, Worcester, MA
New York University School of Medicine, Millburn, NJ
UAB, Birmingham, AL
University of Massachusetts Medical School, Worcester, MA
Univ of Wisconsin School of Medicine and Public Health. Madison, WI

Purpose:

We examined the relationship between disease activity and provider prescribing practices prior to publication of the ACR treatment recommendations using a multi-centered observational registry within the United States (the Consortium of Rheumatology Researchers of North America: CORRONA).

Method:

Patients with a diagnosis of rheumatoid arthritis (RA) who were biologic naïve, had a disease duration of <5 years and had >= 2 visits within 6 months prior to 6/15/08 were identified. Patients in remission and low disease activity based on the Clinical Disease Activity Index (CDAI) were excluded. Patients with a poor prognosis based on the ACR treatment recommendations (mHAQ >0.5, secondary Sjogren's syndrome, subcutaneous nodules, serologic positivity or bony erosions on radiographs) were identified. The population was divided into two cohorts. Cohort #1 comprised patients currently on methotrexate (MTX) monotherapy or who had used only MTX as a DMARD in the past. Cohort #2 was comprised of patients who were receiving or had received >= 2 nonbiologic DMARDs. Initiation of biologic DMARDs in response to disease activity (using the CDAI) was identified.

Results:

There were 284 patients in Cohort #1 (Table 1). Among those with moderate disease activity with poor prognostic factors, only 9% received a biologic at the initial visit. In those with high disease activity, 8% received a biologic at the initial visit. Among those in cohort #1 (n=126) with no improvement in disease activity at a follow-up visit, at the conclusion of the 2nd visit a total of 12% were treated with biologics. There were 143 patients in cohort #2 (Table 1). Among those with moderate disease activity with poor prognostic factors, 5% were initiated on a biologic at the initial visit. In those with high disease activity with poor prognostic factors, 8% received a biologic at the initial visit. Among those in Cohort #2 (n=61) with no improvement in disease activity at a follow-up visit, at the conclusion of the 2nd visit a total of 15% were treated with a biologic.

Table 1.

 Cohort #1 (Methotrexate Only)Cohort #2 (>=2 Nonbiologic DMARDs)
 Moderate disease activity* N=130High disease activity N=154Moderate disease activity* N=81High disease activity* N=62
Care consistent with ACR treatment recommendations
Biologic initiated (N,%)12 (9)13(8)4 (5)5 (8)
Care not consistent with ACR treatment recommendations
No DMARD therapy (N,%)13 (10)35 (23)10 (12)9 (15)
Nonbiologic DMARD therapy maintained (N,%)99 (76)105 (68)67 (83)47 (76)
A nonbiologic DMARD initiated (N,%)6 (5)1 (1)0 (0)3 (5)
* associated with poor prognostic factors

Conclusion:

Prior to publication of the ACR treatment recommendations, most patients with active disease did not receive recommended therapy. Further exploration of the barriers to optimal medication use is necessary.

To cite this abstract, please use the following information:
Harrold, Leslie R., Greenberg, Jeffrey D., Curtis, Jeffrey R., Bentley, Mary jane, Reed, George, Harrington, J. Timothy; Rheumatologists Prescribing Patterns for Rheumatoid Arthritis Patients with Active Disease [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1009
DOI: 10.1002/art.26086

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