Changes in cotherapies after initiation of disease‐modifying antirheumatic drug therapy in patients with rheumatoid arthritis
Objective We hypothesized that initiation of a new disease‐modifying antirheumatic drug (DMARD) for treatment of rheumatoid arthritis (RA) would decrease the use of corticosteroids, nonsteroidal antiinflammatory drugs (NSAIDs), and narcotics. Methods Using administrative databases, we assembled 4 re...
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Published in | Arthritis care & research (2010) Vol. 63; no. 10; pp. 1415 - 1424 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.10.2011
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Subjects | |
Online Access | Get full text |
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Summary: | Objective
We hypothesized that initiation of a new disease‐modifying antirheumatic drug (DMARD) for treatment of rheumatoid arthritis (RA) would decrease the use of corticosteroids, nonsteroidal antiinflammatory drugs (NSAIDs), and narcotics.
Methods
Using administrative databases, we assembled 4 retrospective cohorts of RA patients (1998–2005) and identified 5 groups initiating DMARD regimens: methotrexate (MTX) with (new MTX) or without (first MTX) use of other nonbiologic DMARDs in the previous year; new hydroxychloroquine (HCQ) and/or sulfasalazine (SSZ; new HCQ/SSZ) and new leflunomide (new LEF), both with previous use of MTX; and new tumor necrosis factor α (TNFα) antagonists (new anti‐TNF). We compared within‐person differences in any use of cotherapies (≥1 prescription) between the 6 months before and the 6–12 months after DMARD initiation.
Results
Among 32,476 DMARD initiators, the prevalence of corticosteroid, NSAID, and narcotic use increased by 15%, 5%, and 6%, respectively, in the 6 months before initiation compared to the previous 6 months, suggesting worsening of the disease. In the 6–12 months after initiation for most initiator groups, more patients stopped using corticosteroids and NSAIDs than started, with overall decreases of 8.9% (95% confidence interval [95% CI] 8.4–9.4%) for corticosteroids and 12.9% (95% CI 12.3–13.4%) for NSAIDs. The proportion of narcotic users changed little (overall decrease of 2.5%; 95% CI 1.9–3.0%).
Conclusion
Use of all 3 cotherapies increased in the 6 months before initiation of new DMARD regimens for RA. Use of corticosteroids and NSAIDs decreased modestly 6–12 months after initiation, but there was only a very small decrease in narcotic use. These differential changes require further study. |
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Bibliography: | Dr. Herrinton has received research support from Centocor, Genentech, and Procter & Gamble. Dr. Curtis has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Centocor, Pfizer, and BMS, and (more than $10,000 each) from Amgen, Consortium of Rheumatology Researchers of North America, Roche/Genentech, and UCB. Dr. Griffin has received consultant fees, speaking fees and/or honoraria (less than $10,000 each) from Rocky Mountain Poison and Drug Center funded by McNeil. Dr. Solomon has received research support from Abbott and Amgen. Dr. Delzell has received research support from Amgen. |
ISSN: | 2151-464X 2151-4658 |
DOI: | 10.1002/acr.20550 |