title: Baseline factors predicting change from the initial DMARD treatment during the first 2 years of rheumatoid arthritis: experience in the ERAN inception cohort.
abstract: BACKGROUND
  Outcomes in early Rheumatoid Arthritis (RA) may be improved by rapidly establishing a stable and effective disease modifying anti-rheumatic drug (DMARD) treatment regimen. We aimed to investigate whether baseline factors and initial treatment strategies are associated with changes to the first DMARD treatment, due to either Lack of Efficacy (LoE) or Adverse Drug Reaction (ADR) within 2 years of presentation.
  
  
  METHODS
  Reasons for changes from initial DMARD therapy within 2 years of baseline, and associated factors, were examined using logistic regression in data from the Early RA Network (ERAN) inception cohort.
  
  
  RESULTS
  Data were available for 766 participants. 410 (54%) changed their initial DMARD regime within 2 years, including 230 (56%) due to Lack of Efficacy (LoE) and 139 (34%) due to Adverse Drug Reaction (ADR). The first DMARD was recorded as methotrexate monotherapy in 336 (44%), sulphasalazine monotherapy in 273 (36%), or combined methotrexate/sulphasalazine/hydroxychlorquine in 52 (7%).Baseline predictors of changing DMARD (for all reasons) were HAQ-disability (aOR 1.44, 95% CI 1.12 - 1.86), poor mental health (aOR 1.44, 95% CI 1.16 - 1.78) and extra-articular disease (aOR 1.78, 95% CI 1.00 - 3.16). In this model, the triple combination therapy also predicted lower likelihood of DMARD change (aOR 0.30, 95% CI 0.12 - 0.79).Subgroup analyses showed that MTX monotherapy was associated with lower risk of change due to ADR. Combination therapy conferred lower risk of change due to LoE. Poor mental health was associated with change due to ADR, and extra-articular disease, HAQ-disability at baseline, and younger age predicted LoE.
  
  
  CONCLUSIONS
  Our findings suggest that non-pharmacological interventions to improve disability and mental health, may reduce initial DMARD treatment failure.
authors: Division of Academic Rheumatology, Arthritis Research UK Pain Centre, City Hospital, Nottingham, UK. dan.mcwilliams@nottingham.ac.uk
authors: Daniel F
authors: DF
authors: McWilliams
authors: Patrick D W
authors: PD
authors: Kiely
authors: Adam
authors: A
authors: Young
authors: David A
authors: DA
authors: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D004185:Disability Evaluation; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006304:Health Status; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012460:Sulfasalazine / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D008727:Methotrexate
references: Arthritis Res Ther. 2011 Aug 15;13(4):R131
references: 21843325
references: Arthritis Rheum. 1980 Feb;23(2):137-45
references: 7362664
references: Best Pract Res Clin Rheumatol. 2007 Oct;21(5):907-27
references: 17870035
references: Best Pract Res Clin Rheumatol. 2001 Mar;15(1):67-76
references: 11358415
references: Rheumatology (Oxford). 2009 Jan;48(1):57-60
references: 18984608
references: Rheumatology (Oxford). 2011 Jan;50(1):176-83
references: 20929970
references: J Rheumatol. 1990 Aug;17(8):994-1002
references: 1976811
references: J Rheumatol. 1992 Dec;19(12):1885-94
references: 1294735
references: Rheumatology (Oxford). 2010 Jul;49(7):1267-71
references: 20008093
references: J Rheumatol. 1991 Sep;18(9):1323-7
references: 1757932
references: J Rheumatol. 1991 May;18(5):672-7
references: 1865411
references: Intern Med J. 2011 Jun;41(6):450-5
references: 20403067
references: Arthritis Res Ther. 2010;12(3):R97
references: 20487520
references: Pain. 2011 Feb;152(2):291-299
references: 20961687
references: J Rheumatol. 1997 Nov;24(11):2097-105
references: 9375866
references: J Rheumatol. 2002 Feb;29(2):261-6
references: 11838843
references: J Rheumatol. 2004 Dec;31(12):2366-73
references: 15570636
references: QJM. 2001 Jun;94(6):309-19
references: 11391029
references: Rheumatology (Oxford). 2007 Feb;46(2):350-7
references: 16908509
references: Baillieres Clin Rheumatol. 1995 Nov;9(4):619-32
references: 8591645
references: Musculoskeletal Care. 2007 Sep;5(3):148-59
references: 17590885
references: Arthritis Rheum. 1988 Mar;31(3):315-24
references: 3358796
references: J Rheumatol. 1999 Nov;26(11):2337-43
references: 10555887
references: Arthritis Care Res (Hoboken). 2012 Oct;64(10):1505-13
references: 22556121
references: J Rheumatol. 2006 Feb;33(2):248-55
references: 16358365