The epidemiology of drug treatment failure in rheumatoid arthritis.

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Baillieres Clin Rheumatol. 1995 Nov;9(4):619-32.

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The epidemiology of drug treatment failure in rheumatoid arthritis.

Wolfe F.

University of Kansas School of Medicine, Arthritis Research and

Clinical Centers, Emporia 67214, USA.

The length of time that patients remain on anti-rheumatic therapy is

an important measure of the effectiveness of that therapy since

length of time on therapy is a composite measure that accounts for

sustained, positive therapeutic benefit as well as negative

therapeutic benefit (e.g. adverse reactions, unacceptable costs and

loss of efficacy), and accounts for noise (non-compliance,

psychological factors, misunderstanding, etc.). Effectiveness is a

measure of how well a drug does work, while efficacy, the measure

used in randomized controlled trials, means that a drug can work;

however, efficacy may or may not translate to usefulness in the

clinic. To understand drug effectiveness we reviewed studies of 5809

patients receiving various SMARDs. The average median time on drug

ranged from 1.10 to 2.27 years, excluding methotrexate, with shortest

survival times falling to sulfasalazine (1.10) and auranofin (1.16),

intermediate times to hydroxychloroquine (1.59), penicillamine

(1.42), IM gold (1.40), and the longest time to azathioprine (2.27).

Overall, excluding methotrexate, the average median survival time was

1.41 for 3998 patients. Median time on drug was 3.3 times greater for

all other drugs combined, averaging 4.61 years. Expressed in terms of

'5-year survival,' an average of 55.7% of patients remained on

methotrexate 5 years after it was started. Better results noted here

for methotrexate stand in contradistinction to short-term randomized

controlled trials which find most SMARDs to be equal in efficacy.

Other factors that may influence drug survival time include age, age,

education level, psychological status, presence of fibromyalgia, rank

order of SMARD administration, disease severity or corticosteroid

administration. Studies can provide more information if they also

measure clinical variables as well as time on drug, providing area-

under-the-curve measurements.

PMID: 8591645 [PubMed - indexed for MEDLINE]