Changes in cotherapies after initiation of disease‐modifying antirheumatic drug therapy in patients with rheumatoid arthritis

• Published in: Arthritis care & research (2010) Vol. 63; no. 10; pp. 1415 - 1424
• Main Authors: Kawai, Vivian K., Grijalva, Carlos G., Arbogast, Patrick G., Curtis, Jeffrey R., Solomon, Daniel H., Delzell, Elizabeth, Chen, Lang, Ouellet‐Hellstrom, Rita, Herrinton, Lisa, Liu, Liyan, Mitchel, Edward F., Stein, C. Michael, Griffin, Marie R.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.10.2011
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Antirheumatic Agents - administration & dosage; Arthritis, Rheumatoid - drug therapy; Cohort Studies; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Hydroxychloroquine - administration & dosage; Isoxazoles - administration & dosage; Male; Methotrexate - administration & dosage; Middle Aged; Narcotics - administration & dosage; Retrospective Studies; Sulfasalazine - administration & dosage; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• DOI: 10.1002/acr.20550
• ISSN: 2151-464X

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.