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.


The Impact of the ACR Treatment Recommendations on Physician Prescribing in a U.S. Cohort of Rheumatoid Arthritis Patients.

Harrold3,  Leslie R., Greenberg1,  Jeffrey D., Curtis5,  Jeffrey R., Furst6,  Daniel E., Bentley4,  Mary Jane, Shan4,  Ying, Reed2,  George

Millburn, NJ
george.reed@umassmed.edu
UMass Medical Schl, Worcester, MA
Umass Medical School
University of Alabama - Brimingham, Birmingham, AL
University of California Los Angeles Medical School, Los Angeles, CA
University of Wisconsin, Madison, WI

Purpose:

To examine changes in prescribing patterns in relation to publication of the American College of Rheumatology (ACR) Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) in Rheumatoid Arthritis (RA). Specifically we examined nonbiologic and biologic DMARD use based on disease activity in order to evaluate the impact of the ACR recommendations on medication patterns.

Methods:

We identified biologic naïve RA patients cared for by US rheumatologists participating in the CORRONA registry with visits prior to and/or at least 6 months after publication of the ACR recommendations on 6/15/08 (time period: 2/02–6/08 vs. 12/08–12/09). Initiation or dose escalation of biologic and nonbiologic DMARDs in response to active disease (using the CDAI) was assessed in comparison to the ACR recommendations. The population was divided into two mutually exclusive cohorts: 1) methotrexate (MTX) only users; and 2) multiple nonbiologic DMARD users. The proportion of patients with treatment regimens compliant with the ACR recommendations before and after publication was compared in the two cohorts stratified by disease activity using regression models adjusting for clustering of physician and geographic region.

Results:

In MTX only users, 91–95% of those with low disease activity and 79–89% of those with moderate disease activity and good prognosis were receiving nonbiologic DMARDs, consistent with the recommendations. Among those with moderate disease activity and poor prognosis, 20–23% had their MTX dose increased and/or initiated another nonbiologic DMARD and 14–15% initiated a biologic, resulting in 34–38% of patients receiving care consistent with the recommendations. Similarly, among those with high disease activity, 24–26% had their MTX dose increased and/or were initiated on a non-biologic DMARD and 18–19% initiated a biologic (43–44% receiving care consistent with the guidelines). In the multiple nonbiologic DMARD users with moderate activity, 44–53% received care consistent with the recommendations (30% had initiation and/or dose escalation of their nonbiologic DMARD therapy and 14–21% initiated a biologic). Among those with high disease activity 50–53% received care consistent with the recommendations (30% with initiation and/or dose escalation of their nonbiologic DMARD therapy and 9–22% initiated on a biologic). In adjusted analyses there were no significant differences in prescribing pratices after publication of the treatment recommendations.

Figure 1. Proportion of patients adherent to the ACR Recommendations stratified by disease activity and drug use.

Conclusions:

Only approximately 40 to 50% of RA patients in the CORRONA US registry with high disease activity or moderate disease activity with a poor prognosis received care consistent with the current ACR treatment recommendations within 6 to 18 months after their release. In addition, publication of the recommendations did not appear to change prescribing patterns.

To cite this abstract, please use the following information:
Harrold, Leslie R., Greenberg, Jeffrey D., Curtis, Jeffrey R., Furst, Daniel E., Bentley, Mary Jane, Shan, Ying, et al; The Impact of the ACR Treatment Recommendations on Physician Prescribing in a U.S. Cohort of Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1010
DOI: 10.1002/art.28777

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