title: A retrospective cohort study: 10-year trend of disease-modifying antirheumatic drugs and biological agents use in patients with rheumatoid arthritis at Veteran Affairs Medical Centers.
abstract: OBJECTIVE
  To evaluate the trends in patterns of disease-modifying antirheumatic drugs (DMARDs) and biological agents use from 1999 to 2009 and to identify patient characteristics associated with different patterns of their use in a national sample of Veterans with rheumatoid arthritis (RA).
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Administrative databases of the USA Department of Veterans Affairs.
  
  
  METHODS
  An incident cohort of 13 254 patients with newly diagnosed RA was identified.
  
  
  METHODS
  Trends and choice of DMARDs and biological agents' usage, and time intervals between RA diagnosis and treatment
  
  
  RESULTS
  Methotrexate use as first-line agent increased from 39.9% to 57.2% over the study period (p<0.001). Although biological dispensations increased over other DMARDs and biological agents, from 3.4% to 25% from 1999 to 2009, the percentage of RA patients diagnosed between 1999 and 2007 who had biologics dispensations remained steady at 23.3-26.7%. Compared with Caucasian, African Americans were less likely to receive biologics (HR 0.71, 95% CI 0.63 to 0.81). Patients aged 75 and older were less likely to receive biologics than those younger than 45 (HR 0.29, 95% CI 0.23 to 0.36). The time interval between RA diagnosis and treatment with DMARDs and biological agents decreased significantly over time (median: 51 days in 1999-2001 to 28 days in 2006-2007).
  
  
  CONCLUSIONS
  Methotrexate use increased as it became the preferred first-line agent, while other traditional agents declined. Dispensation of biologics increased significantly, but the proportion of RA patients eventually given biologics stabilised below 30%. A significant shorter time between RA diagnosis and DMARD or biological agent initiation in recent years suggests improvements in quality of care. There were disproportionately lower use of biologics in certain age and ethnic groups, and further studies will be needed to elucidate these observations.
authors.affiliation: Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, Houston, Texas, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Ng
authors.forename: Adeline
authors.initials: A
authors.lastname: Chu
authors.forename: Myrna M
authors.initials: MM
authors.lastname: Khan
references.citation: Arthritis Care Res (Hoboken). 2010 Jan 15;62(1):101-7
references.pmid: 20191497
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: Rheumatology (Oxford). 2011 Feb;50(2):381-8
references.pmid: 21036875
references.citation: Rheumatology (Oxford). 2002 Dec;41(12):1367-74
references.pmid: 12468815
references.citation: Arthritis Care Res (Hoboken). 2012 Oct;64(10):1490-6
references.pmid: 22623324
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Arthritis Rheum. 2008 Sep 15;59(9):1314-21
references.pmid: 18759262
references.citation: Arthritis Care Res (Hoboken). 2010 Jun;62(6):805-10
references.pmid: 20535791
references.citation: Rheumatology (Oxford). 2008 Jul;47(7):1061-4
references.pmid: 18499716
references.citation: J Rheumatol. 2009 Aug;36(8):1611-7
references.pmid: 19369454
references.citation: Am J Epidemiol. 2000 Feb 1;151(3):307-14
references.pmid: 10670556
references.citation: Ann Rheum Dis. 2010 Jun;69(6):964-75
references.pmid: 20444750
references.citation: Ann Rheum Dis. 2009 Jul;68(7):1100-4
references.pmid: 19060002
references.citation: Arthritis Care Res (Hoboken). 2012 May;64(5):625-39
references.pmid: 22473917
references.citation: N Engl J Med. 1985 Mar 28;312(13):818-22
references.pmid: 3883172
references.citation: Scand J Rheumatol. 1996;25(6):341-4
references.pmid: 8996467
references.citation: Rheumatology (Oxford). 2007 Aug;46(8):1355-8
references.pmid: 17567634
references.citation: Best Pract Res Clin Rheumatol. 2005 Feb;19(1):163-77
references.pmid: 15588977
references.citation: Arthritis Care Res (Hoboken). 2013 Feb;65(2):299-303
references.pmid: 22807272