Rheumatoid arthritis treatment patterns in 2001

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Jul 5, 2002

Rheumatoid arthritis treatment patterns in 2001

Stockholm, Sweden Less than half of rheumatoid arthritis (RA) patients

receive combination therapy and only about 20% use TNF monotherapy,

according to a longitudinal US study presented in a poster at EULAR looking

at RA treatment in 2001. The researchers, headed by Dr Frederick Wolfe

(National Data Bank for Rheumatic Diseases, Wichita, KS), also flag the

" additional considerable use of GI and analgesic therapy among RA patients. "

The team reported data from 6293 US patients collected as part of an ongoing

study of RA outcomes. All of the patients were being treated by a community

rheumatologist, and filled in a mail questionnaire at 6-month intervals in

2001. Rates of drug use were determined in the last month of the 6-month

period.

The results show that DMARD/biologic therapy was used by 78.1% of patients,

DMARDs by 72.7%, and biologics by 20.5% (see table). However, 21.9% of

patients were not receiving any DMARD/biologic treatment.

" While NSAID use has remained constant over the last 36 months, decreases in

traditional NSAIDs (naproxen) have occurred at the time when very large

increases in the use of COX-2 can be seen "

About 63% of patients used NSAIDs, 28.7% COX-2 NSAIDs, 39.3% analgesics, and

37.3% GI drugs related to ulcer or acid treatment, including 20.2% on proton

pump inhibitors (an increase at the expense of H2 blockers and other GI

drugs, note the researchers).

RA therapy in 2001

DMARDs/Biologics/Prednisone 81.6%

DMARDs/Biologics 78.1%

DMARDs 72.7%

Biologics 20.5%

Prednisone 28.0%

NSAIDs 62.9%

COX-2 specific 28.7%

Non-specific 36.6%

Analgesics 39.3%

GI Drugs 37.3%

In terms of DMARD use (regardless of whether they were used in combination

or alone) 49.8% used methotrexate (injectable 12.5%, oral 36.9%), 22.6%

hydroxychloroquine, 11% leflunomide, and 6.1% sulfasalazine. No other DMARD

was used by at least 5% of patients. Of biologics, etanercept was used by

14.2% and infliximab by 6.4%. Prednisone was used by 28% (with a reported

lifetime use of 66.9%).

Monotherapy with a DMARD or a biologic was used by 45.9% of patients, while

combination therapy was used by 32.2% (15% of which included TNF therapy).

Triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine was

used by only 1.1% of all patients.

" While NSAID use has remained constant over the last 36 months, decreases in

traditional NSAIDs (naproxen) have occurred at the time when very large

increases in the use of COX-2 can be seen, " indicate the researchers.

During that period, the use of MTX has remained constant, while there have

been " dramatic straight-line increases " in biologic therapy, with a

corresponding decrease in the use of other DMARDs. The rate of increase in

leflunomide therapy was great over the first 18 months following its

release; the rate has now slowed.