A new report concludes that efforts to improve the use of disease-modifying antirheumatic drugs (DMARDs) should focus on patient age, ethnicity, income and rheumatoid arthritis (RA)-related factors. In particular, the study notes that Hispanic patients were more likely to both start and stop DMARDs.
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“[Although] this sounds counterintuitive, it’s very reasonable that the same demographic factor[s] would be associated with stopping and starting DMARDs,” lead author Daniel Solomon, MD, MPH, wrote in an e-mail interview with The Rheumatologist. “In other words, this group is not stale in their medication use. This may be because of insurance changes or gaps in the continuity of care.”
The American College of Rheumatology began recommending the use of DMARDs for all RA patients with RA in 2002. Dr. Solomon, chief of the section of Clinical Sciences in the Division of Rheumatology at Brigham and Women’s Hospital in Boston, said about 90% of patients now get the treatment.
In the article, “Predictors of Stopping and Starting Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis,” Solomon et al used the University of California San Francisco RA Panel—a longitudinal cohort of patients with RA in Northern California—to explain how demographic factors figure into which patients do not receive the drugs.1
Dr. Solomon said he would like to see similar analyses done with different data sets. He also wants to test whether the factors identified as predictors for starting or stopping DMARDs are important in healthcare settings with quality improvement programs in place. After that, the factors could serve as a guide to targeting patients with inconsistent DMARD use that includes multiple stops and starts, he added.
“The vast majority of rheumatologists know that DMARDs should be (the) standard of care for RA,” Dr. Solomon wrote. “This study is less for [them] and more for health policy executives thinking about ways to improve care for RA.” (posted 9/12/14)
Richard Quinn is a freelance writer in New Jersey.
1. Solomon DH, Tonner C, Lu B, et al. Predictors of stopping and starting disease-modifying antirheumatic drugs for rheumatoid arthritis. Arthritis Care Res (Hoboken). 2014:66(8):1152–1158.