Life table analysis of treatment episodes with disease-modifying anti-rheumatic drugs in rheumatoid arthritis

Abstract

To evaluate the utility of therapy with all the major disease-modifying anti-rheumatic drugs (DMARDs) in long-term treatment, 1666 DMARDs treatment episodes were analyzed using 5-year life tables. In total, all treatment episodes attributable to DMARDs remained in less than 20% of the patients up to 60 months. As for the prevalence of patients remaining in the follow-up study, those receiving methotrexate (MTX) were the most common, those receiving injectable gold compound (GST), bucillamine (BU), andd-penicillamine (DP) were higher than those receiving actalit (ACT) and sulfasalazine (SASP), and those receiving mizoribine (MZR), lobenzarit (CCA), and auranofin (AF) were least. The treatment terminations for inefficacy in BU, DP, and SASP increased slowly over 36 months. For all drugs but GST and MTX, the life table curve of terminations for toxicity became horizontal over time. The prevalence of terminations for toxicity in MTX increased even after 48 months. The long-term utility of DMARDs therapy for RA is unsatisfying. MTX was the most useful, and GST, BU, DP, and SASP were relatively useful. Relapse of the disease occurred with BU, DP, and SASP. We need to observe patients closely for the appearance of side effects throughout the prescription period of MTX irrespective of the duration of treatment.