RESEARCH - Functional improvement after patients with RA start a new DMARD associated with frequent changes in DMARD: CORRONA

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J Rheumatol. 2008 Sep 1. [Epub ahead of print]

Functional Improvement After Patients with Rheumatoid Arthritis Start

a New Disease Modifying Antirheumatic Drug (DMARD) Associated with

Frequent Changes in DMARD: The CORRONA Database.

Ranganath VK, us HE, Onofrei A, Khanna D, G, Elashoff DA,

Kremer JM, Furst DE.

From the Department of Medicine, Division of Rheumatology, University

of California, Los Angeles, California; University of Massachusetts

Medical School, Worcester, Massachusetts; and Center for Rheumatology,

Albany Medical College, Albany, New York, USA.

OBJECTIVE: We examined the relationships of rheumatoid arthritis (RA),

disease duration (DD), number of previous disease modifying

antirheumatic drugs (DMARD), and frequency of DMARD changes, with

regard to changes in function in patients with RA evaluated by

modified Health Assessment Questionnaire (mHAQ) after the start of a

new DMARD. METHODS: In total, 889 patients with active RA from the

CORRONA database [patients had mHAQ >/= 0.5 and/or Disease Activity

Score 28-joint count (DAS28) >/= 1.6] started a new DMARD (baseline)

and had at least one followup visit 6-12 mo later. Change in mHAQ from

baseline to followup visit was modeled using univariate/multivariate

linear regression analysis. Due to colinearity, separate multivariate

regression models were performed including/excluding the predictors

disease duration, number of prior DMARD, and frequency of DMARD

changes. RESULTS: Baseline age, mHAQ, erythrocyte sedimentation rate

(ESR), DAS28, and number of prior DMARD differed across DD groups. The

univariate linear regression model showed that higher baseline values

of mHAQ, DAS28, swollen joint count (SJC), tender joint count (TJC),

Clinical Disease Activity Index (CDAI), ESR, physician global

assessment, prednisone use, and subsequent addition/discontinuation of

DMARD were associated with improvement of the mHAQ at followup (p =

0.05). Multivariate linear regression models showed that mHAQ

improvement was associated with shorter DD, higher baseline mHAQ,

addition of subsequent DMARD, and the DMARD frequency index (no.

previous DMARD/yrs of DD) (p < 0.05). Number of DMARD patients used

previously was not associated with change of mHAQ in either model.

CONCLUSION: Our study demonstrates that in clinical rheumatologic

practices, more frequent changes in DMARD are associated with greater

improvement in function (by mHAQ). It does not support the idea that

number of previous DMARD used predicts response. Indirectly, these

data support the concept that DMARD should be changed if optimal

responses are not achieved within a specified time.

PMID: 18785317

http://www.ncbi.nlm.nih.gov/pubmed/18785317

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