RESEARCH - First-line DMARD choice in early RA - do prognostic factors play a role?

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Rheumatology Advance Access published online on December 11, 2009

Rheumatology, doi:10.1093/rheumatology/kep389

First-line DMARD choice in early rheumatoid arthritis—do prognostic

factors play a role?

Satish M. Rachapalli1, 2, A. Walsh3, Adam

Young4, D. W. Kiely5, and, Ernest H. Choy1 on behalf of the

Early Rheumatoid Arthritis Network (ERAN)

1Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of

Rheumatology, King’s College London, London, 2Department of

Rheumatology, Hereford County Hospital NHS Trust, Hereford, 3Academic

Rheumatology, University of Nottingham, Nottingham, 4St Albans City

Hospital and 5Department of Rheumatology, St ’s Healthcare NHS

Trust, London, UK.

Abstract

Objective. To examine if prognostic factors predict the choice of

first DMARD for patients with RA.

Methods. Details of 616 patients with early RA were collected from 16

centres in the UK Early Rheumatoid Arthritis Network (ERAN). Logistic

regression was used to identify whether HAQ score, swollen joint count

(SJC), nodules, RF, ESR, CRP and erosions on radiographs were

associated with the choice of first DMARD treatment.

Results. Of 616 patients, 547 (88%) were started on a DMARD, 253 (46%)

on MTX, 230 (42%) on SSZ, 47 (9%) on other DMARD monotherapies and 17

(3%) on combination DMARD therapy (CoT). SSZ was started less

frequently in patients with positive RF (P = 0.018; OR 0.59; 95% CI

0.38, 0.91) and high SJC (P = 0.02; OR 0.95; 95% CI 0.91, 0.99). MTX

was favoured in patients with high SJC (P = 0.002; OR 1.07; 95% CI

1.02, 1.11). Non-prescription of DMARDs was associated with old age (P

= 0.02; OR 0.98; 95% CI 0.96, 0.99) and low HAQ score (P = 0.009; OR

0.80; 95% CI 0.68, 0.95). None of the variables predicted CoT. All

other variables and the hospital where the patient was treated were

not independently associated with the choice of DMARD.

Conclusions. When choosing DMARD monotherapy in early RA,

rheumatologists in ERAN seem to preferentially prescribe MTX for

patients with a poor prognosis and SSZ for patients with good

prognosis. No DMARDs were used in older patients or in those with a

low HAQ.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep389v1?papetoc

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