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

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Rheumatology (Oxford). 2008 Jul;47(7):1061-4. Epub 2008 May 22.

Changing patterns of medication use in patients with rheumatoid

arthritis in a Medicaid population.

Grijalva CG, Chung CP, Stein CM, Mitchel EF Jr, MR.

Department of Preventive Medicine, Vanderbilt University School of

Medicine, 1500 21st Avenue, 2600 VAV, Nashville, TN 37212, USA.

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.

PMID: 18499716

http://www.ncbi.nlm.nih.gov/pubmed/18499716

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