Many Patients With RA Not Receiving Timely DMARD Adjustment

10/03/17

Approximately 40% of patients with rheumatoid arthritis (RA) with persistent moderate to high disease activity waited at least 90 days for adjustment of their disease-modifying antirheumatic drug (DMARD) therapy, according to a recent study published in Arthritis Care & Research (online September 21, 2017; doi:10.1002/acr.23418).

Additionally, the study reports that 32.3% of patients waited at least 180 days for DMARD therapy adjustment.

Current American College of Rheumatology guidelines recommend patients with RA with moderate to high disease activity have their DMARD therapy adjusted at least every 3 months until achieving low disease activity or remission.

Yomei Shaw, PhD, University of Pittsburgh, and colleagues conducted a study to examine how quickly patients with RA with moderate to high disease activity had their DMARD therapy adjusted in clinical practice. A total of 538 patients with moderate to high disease activity in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research registry were sampled. Researchers conducted a competing risks regression on time to DMARD therapy adjustment. Cox regression was also conducted to assess time to low disease activity or remission.

Researchers reported that 60% of patients with persistent moderate to high disease activity had their DMARD therapy adjusted within 90 days. Among the total patient population, the median times to DMARD adjustment and low disease activity or remission was 154 days and 301 days, respectively.

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Among the factors associated with longer time to DMARD therapy adjustment were older age (HR, 0.61; P = .02), lower baseline disease activity (HR, 0.72; P < .01), longer duration of disease (HR, 0.98; P < .01), and biologic use (HR, 0.71; P < .01).

Factors associated with longer time to low disease activity or remission included African-American race (HR, 0.63; P = .01), higher baseline disease activity (HR, 0.75; P < .01), and not having DMARD therapy adjusted within 90 days (HR, 0.76; P = .01).

Researchers concluded that adjusting DMARDs within 90 days is associated with shorter times to low disease activity or remission. However, a large percentage of patients with persistent moderate to high disease activity had to wait longer than 90 days to have their DMARD therapy adjusted. “Interventions are needed to address the timeliness of DMARD adjustments for RA patients with,” researchers wrote.—Zachary Bessette