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Rheumatoid arthritis pharmacotherapy and predictors of disease-modifying anti-rheumatic drug initiation in the early years of biologic use in Quebec, Canada

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Abstract

Disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis (RA) pharmacotherapy and should be initiated promptly after RA diagnosis. We examined trends in use of traditional and biologic DMARDs, and non-DMARD treatments, among overall RA patients, and factors associated with DMARD initiation in the newly diagnosed RA. RA subjects identified with the Quebec administrative databases were followed between January 1, 2002, and December 31, 2008. DMARD use was characterized on November 1 of each year using cross-sectional analyses. For a subgroup of newly diagnosed subjects, we used multivariable logistic regressions to identify predictors of DMARD initiation within 12 months of diagnosis and survival analyses to appraise time to DMARD initiation. A total of 37,399 subjects were included (65.8 % ≥65 years; 70.5 % female). The percentage of subjects using any DMARDs increased over the study period from 41.4 % [95 % confidence interval (CI) 40.8–42.0] to 43.3 % (95 % CI 42.7–43.9). Among newly diagnosed RA, being followed by a rheumatologist was the strongest predictor of DMARD initiation (odds ratio 4.31; 95 % CI 3.73–4.97). Care by an internist, increasing calendar year, use of NSAIDs, corticosteroids, or opioids, and a history of hospitalization increased the likelihood of DMARD initiation. Older age, female, higher comorbidity score, number of medical visits pre-diagnosis, care by other specialists, and the use of acetaminophen were inversely associated with DMARD initiation. The probability of any DMARD initiation at 12 months was 38.5 %. Despite the clinical practice guideline recommendations for earlier aggressive RA management, DMARD use appears to be suboptimal in Quebec.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940 Chemin de la polytechnique, Office 2252, Montreal, QC, H3C 3J7, Canada

    Jean-Pascal Roussy & Jean Lachaine

  2. Laval University, Centre Hospitalier Universitaire de Québec-CHUL, 2705 boulevard Laurier, Quebec, QC, G1V 4G2, Canada

    Louis Bessette

  3. Department of Medicine, McGill University, Research Institute of the McGill University Health Centre, Royal Victoria Hospital, V Building (Rm. V2.11), 687 Pine Avenue West, Montreal, QC, H3A 1A1, Canada

    Elham Rahme

  4. Research Institute of the McGill University Health Centre, McGill University, A6-1650 Cedar Ave, Montreal, QC, H3A 1A4, Canada

    Sasha Bernatsky

  5. Arthritis Alliance of Canada, Neuville, QC, Canada

    Jean Légaré

Authors
  1. Jean-Pascal Roussy
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  2. Louis Bessette
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  3. Elham Rahme
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  4. Sasha Bernatsky
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  5. Jean Légaré
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  6. Jean Lachaine
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Correspondence to Jean-Pascal Roussy.

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Roussy, JP., Bessette, L., Rahme, E. et al. Rheumatoid arthritis pharmacotherapy and predictors of disease-modifying anti-rheumatic drug initiation in the early years of biologic use in Quebec, Canada. Rheumatol Int 34, 75–83 (2014). https://doi.org/10.1007/s00296-013-2828-7

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  • DOI: https://doi.org/10.1007/s00296-013-2828-7

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