Huge European survey suggests doctors should listen to patients more closely and treat RA more aggressively

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Huge European survey suggests doctors should listen to patients more closely

and treat RA more aggressively

New Orleans, LA A European survey involving more than 6000 patients, the

majority with rheumatoid arthritis (RA), has found that most patients are

being treated with only 1 disease modifying agent against rheumatic disease

(DMARD) and continue to have active disease [1]. Many patients rated their

current health status lower than did their physicians and reported being

more severely affected by the disease than the physicians perceived them to

be.

These results, from the Co-operative on Quality of Life (COP-QoL) survey in

rheumatic diseases, suggest that doctors should listen to their patients

more closely and that they should treat RA more aggressively, says Dr

Christian Antoni (University of Erlangen, Germany).

Antoni was presenting the findings at a poster session at the American

College of Rheumatology meeting last week, on behalf of a team of European

specialists that also include Dr Ravinder Maini (Kennedy Institute, London,

UK), Dr f Smolen (University of Vienna, Austria), and Dr Jochen Kalden

(University of Erlangen, Germany). The survey, conducted across 11 European

countries in November 2001, was sponsored by Schering-Plough/Centocor,

manufacturers of infliximab (Remicade ®). The database is held at the

University of Erlangen, and the responses were analyzed there.

The survey involved 6124 outpatients and their physicians (who were blinded

to the patients' responses), Antoni reported. The majority of patients

(89.4%) were diagnosed with RA. Approximately one third had the disease for

10 years or more, and 33.7% were unemployed due to their disease, he noted.

A further 10.6% of participating patients had ankylosing spondylitis (AS);

of these, 42% had a disease duration of 10 years or more, and nearly half

(47.1%) were unemployed due to their diseases.

The 5158 patients with RA made frequent visits to see a specialist for their

disease. Over the previous year, 32.6% had visited a specialist between 1

and 3 times; 34.6% had 4 to 6 visits; 16% had 7 to 10 visits, and a further

16% made more than 10 visits.

The RA patients had a mean score of 1.14 on the Health Assessment

Questionnaire (HAQ) and a mean score of 4.11 on the Rheumatoid Arthritis

Disease Activity Index (RADAI). The AS patients had a mean score of 4.24 on

the Bath Ankylosing Spondylitis Functional Index (BASFI). " These results

indicate that the burden of RA and AS is still remarkably high across Europe

and that a majority of patients have substantial disease activity, " Antoni

commented.

In addition, patients' self-assessments consistently showed that they felt

they were more severely affected by their disease than their physicians

thought that they were. Among both the RA and the AS groups, the patients'

perception of general health was 5.0, compared with their physicians'

perception of 3.8. Antoni told rheumawire that these results suggest that

" doctors should give more consideration to their patients' point of view. "

Some indication of current treatment patterns in Europe

The survey also gave some indications of current treatment patterns in

Europe. " Overall, there are more patients on methotrexate or on a DMARD than

there used to be, say about 10 years ago, " Antoni commented, and so this can

be viewed as a success. However, the majority of these patients are on

monotherapy 90% of patients were taking 1 DMARD and in many patients the

disease is still active and patients are becoming disabled by their disease,

he said. Only 10% of patients were on combination therapy, and about only

about 10% of these European patients were using a biological agent (ie, 1 of

the TNF-inhibitors, etanercept [Enbrel®, Wyeth Pharmaceuticals and Amgen] or

infliximab [Remicade]) or the interleukin-1-antagonist anakinra [KineretTM,

Amgen]. This contrasts with figures from North America, Antoni said, where

an estimated 15% to 20% of patients are using a biologic. These findings

suggest that patients with RA should be treated more aggressively, Antoni

commented.

Zosia Chustecka