RESEARCH - Changing patterns of medication use in patients with RA in a Medicaid population

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Rheumatology Advance Access published online on May 22, 2008

Rheumatology, doi:10.1093/rheumatology/ken193

Changing patterns of medication use in patients with rheumatoid

arthritis in a Medicaid population

C. G. Grijalva1, C. P. Chung2, C. M. Stein2, E. F. Mitchel, Jr1 and M.

R. 1,2,3,4

1Department of Preventive Medicine, 2Department of Medicine,

Vanderbilt University School of Medicine, 3The Mid-South Geriatric

Research Education and Clinical Center and 4Clinical Research Center

of Excellence, VA Tennessee Valley Health Care System, Nashville, TN,

USA.

Abstract

Objective. To examine changes in patterns of medication utilization in

patients with RA.

Methods. Data from Tennessee Medicaid (TennCare) databases (1995–2004)

were used to identify adults with both a diagnosis of RA and at least

one DMARD prescription each year. Annual age-specific utilization of

DMARDs, glucocorticoids, NSAIDs and narcotics was measured on the last

day of each year to determine the point prevalence of use of these

agents.

Results. Records from 23 342 patients with treated RA were analysed.

Most patients were females (78%) and white (74%). The median age was

57 yrs (interquartile range: 48–65). The proportion of patients who

had a current DMARD prescription on the index date increased from 62%

in 1995 to 71% in 2004 (P < 0.001). MTX was the most commonly used

DMARD. By the end of 2004, 22% of patients had a current prescription

for a biologic, and etanercept represented 51% of all biologic

therapies. During the study period, the overall utilization of

glucocorticoids decreased from 46% to 38% (P < 0.001), whereas NSAID

utilization increased from 33% to 38% (P < 0.001), and use of

narcotics increased from 38% to 55% (P < 0.001). A secondary analysis

that identified RA patients based on diagnosis codes alone, showed

similar patterns, but lower DMARD utilization which increased from 33%

to 52% overall and from 0% to 16% for biologics.

Conclusions. The utilization of DMARDs increased in TennCare patients

with RA, and by 2004, use of biologics was substantial. Although

glucocorticoid utilization decreased, use of both NSAIDs and narcotics

increased.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken193v1?papetoc

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