Abstract
This study aimed at providing a current and nearly complete picture of the patterns of the initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with newly diagnosed RA. Based on ambulatory drug prescription data and physician billing claims data covering 87% of the German population, we assembled a cohort of incident RA patients aged 15–79 years (n = 54,896) and assessed the prescription frequency of total DMARDs, conventional synthetic (csDMARDs) and biologic DMARDs (bDMARDs) within the first year of disease. Using multiple logistic regression, we estimated the chance of early DMARD receipt based on age, sex, serotype and specialty of prescribing physician while controlling for region of residence. In total, 44% of incident RA patients received a DMARD prescription within the first year of disease. In multiple regression, younger patients (< 35 years) had 1.7-fold higher chances of receiving a csDMARD than patients aged ≥ 65 years [odds ratio (OR): 1.65 with 95% confidence interval (CI) 1.51–1.80] and almost tenfold higher chances to receive a bDMARD [OR (95% CI) 9.5 (8.0–11.3)]. Seropositivity and a visit to a rheumatologist were positively associated with DMARD initiation [OR (95% CI) 2.8 (2.6–2.9) and 5.9 (5.6–6.2) for csDMARDs, respectively]. Based on data covering 87% of the German population, the present study revealed that less than half of incident RA patients receive DMARDs within the first year of disease and that marked differences exist according to age. The study highlights the importance of involving a rheumatologist early in the management of RA.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of synovial tissues that leads to progressive, irreversible joint destruction, impaired joint function and pain [1]
44% of the incident RA patients received a disease-modifying antirheumatic drugs (DMARDs) within the first year of RA disease (Table 2)
A total of 3.3% was prescribed a biologic DMARDs (bDMARDs) within the first year of disease
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of synovial tissues that leads to progressive, irreversible joint destruction, impaired joint function and pain [1] It is one of the most prevalent chronic inflammatory diseases, affecting approximately 1% of the adult population in developed nations worldwide [2]. Aggressive treatment during the early phase of RA has been shown to be more likely to succeed in preventing long-term sequelae and preserving functional status compared to the same treatment applied at later stages of the disease This therapeutic ‘window-of-opportunity’ is widely accepted and refers to the timely initiation of DMARD therapy, ideally within the first 3 months of disease onset. Regular monitoring of the disease activity and adjustments of the therapy to the target of sustained remission (or low disease activity if remission is unattainable) are important aspects of the T2T strategy consistently embedded into national and international recommendations [6,7,8,9,10,11]
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