Prescribing practices in a US cohort of rheumatoid arthritis patients before and after publication of the American College of Rheumatology treatment recommendations
Open Access
- 27 September 2011
- journal article
- research article
- Published by Wiley in Arthritis & Rheumatism
- Vol. 64 (3), 630-638
- https://doi.org/10.1002/art.33380
Abstract
Objective To examine prescribing practices in the use of biologic and nonbiologic disease‐modifying antirheumatic drugs (DMARDs) to treat patients with rheumatoid arthritis (RA), before and after publication of the American College of Rheumatology (ACR) treatment recommendations. Methods Biologics‐naive RA patients under the care of a rheumatologist in the US were identified from the Consortium of Rheumatology Researchers of North America registry. Patients were included if their visits occurred prior to and/or at least 6 months after publication of the ACR treatment recommendations (time periods of February 2002–June 2008 versus December 2008–December 2009). The population was divided into 2 mutually exclusive cohorts: 1) methotrexate (MTX) monotherapy users, and 2) multiple nonbiologic DMARD users. Initiation or dose escalation of biologic and nonbiologic DMARDs in response to active disease was assessed cross‐sectionally and longitudinally in comparison to the ACR recommendations. The impact of the publication of the ACR recommendations on treatment practices was assessed using logistic regression, stratified by disease activity and adjusted for clustering of physicians and geographic region. Results After 1 visit, 24–37% of patients receiving MTX monotherapy who had moderate disease activity and a poor prognosis or high disease activity received care consistent with the ACR recommendations; after 2 visits, 34–56% of the MTX monotherapy group received care consistent with the recommendations. In the patients receiving multiple nonbiologic DMARDs, 31–47% of those with moderate or high disease activity received care consistent with the recommendations after 1 visit, and 43–51% received such care after 2 visits. Publication of the recommendations did not significantly change treatment patterns for those with active disease. Conclusion Substantial numbers of RA patients with active disease did not receive care consistent with the current ACR treatment recommendations. Innovative approaches to improve care are necessary.Keywords
Funding Information
- NIH (AR-053856, AR-053351, AR-054412)
- Arthritis Foundation
- Abbott
- Amgen
- Bristol-Myers Squibb
- Centocor
- Genentech
- Lilly
- Roche
This publication has 22 references indexed in Scilit:
- Treating rheumatoid arthritis to target: recommendations of an international task forceAnnals Of The Rheumatic Diseases, 2010
- Physician preference motivates the use of anti–tumor necrosis factor therapy independent of clinical disease activityArthritis Care & Research, 2009
- Evaluation of composite measures of treatment response without acute-phase reactants in patients with rheumatoid arthritisRheumatology, 2009
- The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR CohortThe Journal of Rheumatology, 2009
- American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease‐modifying antirheumatic drugs in rheumatoid arthritisArthritis Care & Research, 2008
- Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part IArthritis & Rheumatism, 2007
- The CORRONA databaseAnnals Of The Rheumatic Diseases, 2005
- Therapeutic strategies in early rheumatoid arthritisBest Practice & Research Clinical Rheumatology, 2005
- Effect of cardiovascular comorbidities and concomitant aspirin use on selection of cyclooxygenase inhibitor among rheumatologistsArthritis Care & Research, 2005
- The American college of rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trialsArthritis & Rheumatism, 1993