Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Large Discrepancy between Expected and Observed Ratios of Biologic Treated Rheumatoid Arthritis Patients Also Compliant on DMARDs.

Choquette2,  Denis, Arundine1,  Mark, Thomas1,  Oliver

Mississauga, ON, Canada
Institut de Rhumatologie de Montréal, Montreal, QC, Canada


It is common for most Canadian Rheumatologists to prescribe a biologic in combination with one or more DMARDS to 80–90% of their RA patients. Despite this practise, databases linked to drug plans indicate that RA patients receiving biologics do not fulfill DMARD scripts, and especially methotrexate at the same level as is prescribed by physicians. This study, examines this discrepancy more closely and suggests potential causal etiologies.


Biologic and DMARD concomitant therapy based on actual patient purchases was examined by tracking 6,744 anonymous patient records from public and private drug plans in Quebec and Ontario through a licensed 3rd party. A treatment algorithm criterion was applied to isolate RA patients. All patients who purchased a biologic for the treatment of RA over a 1 month period were monitored to determine if they filled prescriptions for DMARDS within a period of 90 days before and 90 days after they purchased their biologic. The month of September 2009 was randomly selected and deemed as a typical representative month. Each patient was linked in the public or private system with a unique identifier so that their acquisition of all drugs through their drug plan could be monitored over time to determine the relative prevalence of biologic monotherapy vs. combination therapy with a DMARD based on drug purchases.


Among patients on their first biologic for more than 6 months, 45% did not purchase a DMARD. Likewise, 41% of patients who were on biologic therapy for more than 24 months did not purchase a DMARD. For patients on their 2nd biologic, rates of patients who did not purchase a DMARD ranged from 36% to 38% over the same time period. Furthermore, the proportion of patients on their first biologic who did not purchase methotrexate ranged from 58% for those on biologic therapy for more than 6 months to 54% for those on therapy for more than 24 months.


Despite what is prescribed by physicians, the data suggests that many RA biologic patients do not comply with taking DMARDs as directed. This is especially evident for those patients prescribed methotrexate. These findings also suggest that approximately half of RA biologic patient's studied in this cohort failed to adhere to expected treatment regimes. This rate is inconsistent with the majority of physician's intended treatment regimens. Reasons for this discrepancy include efficacy and safety elements. Closer examination of actual combination therapy, compliance rates and therapy discontinuation at the patient level warrants further investigation.

To cite this abstract, please use the following information:
Choquette, Denis, Arundine, Mark, Thomas, Oliver; Large Discrepancy between Expected and Observed Ratios of Biologic Treated Rheumatoid Arthritis Patients Also Compliant on DMARDs. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :74
DOI: 10.1002/art.27843

Abstract Supplement

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