title: Rheumatoid arthritis pharmacotherapy and predictors of disease-modifying anti-rheumatic drug initiation in the early years of biologic use in Quebec, Canada.
abstract: Disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis (RA) pharmacotherapy and should be initiated promptly after RA diagnosis. We examined trends in use of traditional and biologic DMARDs, and non-DMARD treatments, among overall RA patients, and factors associated with DMARD initiation in the newly diagnosed RA. RA subjects identified with the Quebec administrative databases were followed between January 1, 2002, and December 31, 2008. DMARD use was characterized on November 1 of each year using cross-sectional analyses. For a subgroup of newly diagnosed subjects, we used multivariable logistic regressions to identify predictors of DMARD initiation within 12 months of diagnosis and survival analyses to appraise time to DMARD initiation. A total of 37,399 subjects were included (65.8 % ≥65 years; 70.5 % female). The percentage of subjects using any DMARDs increased over the study period from 41.4 % [95 % confidence interval (CI) 40.8-42.0] to 43.3 % (95 % CI 42.7-43.9). Among newly diagnosed RA, being followed by a rheumatologist was the strongest predictor of DMARD initiation (odds ratio 4.31; 95 % CI 3.73-4.97). Care by an internist, increasing calendar year, use of NSAIDs, corticosteroids, or opioids, and a history of hospitalization increased the likelihood of DMARD initiation. Older age, female, higher comorbidity score, number of medical visits pre-diagnosis, care by other specialists, and the use of acetaminophen were inversely associated with DMARD initiation. The probability of any DMARD initiation at 12 months was 38.5 %. Despite the clinical practice guideline recommendations for earlier aggressive RA management, DMARD use appears to be suboptimal in Quebec.
authors: Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940 Chemin de la polytechnique, Office 2252, Montreal, QC, H3C 3J7, Canada, jean-pascal.roussy@live.com.
authors: Jean-Pascal
authors: JP
authors: Roussy
authors: Louis
authors: L
authors: Bessette
authors: Elham
authors: E
authors: Rahme
authors: Sasha
authors: S
authors: Bernatsky
authors: Jean
authors: J
authors: Légaré
authors: Jean
authors: J
authors: Lachaine
references: J Rheumatol. 2005 Jun;32(6):1043-6
references: 15940765
references: Best Pract Res Clin Rheumatol. 2009 Feb;23(1):83-92
references: 19233048
references: J Rheumatol. 2011 Jul;38(7):1282-8
references: 21572157
references: Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
references: 23592598
references: J Clin Epidemiol. 1992 Jun;45(6):613-9
references: 1607900
references: Arthritis Rheum. 2008 Jun 15;59(6):762-84
references: 18512708
references: J Clin Epidemiol. 1995 Aug;48(8):999-1009
references: 7775999
references: J Rheumatol. 2012 Aug;39(8):1559-82
references: 21921096
references: Arthritis Rheum. 2005 Apr 15;53(2):241-8
references: 15818655
references: Clin Exp Rheumatol. 2013 Mar-Apr;31(2):256-62
references: 23305590
references: Ann Rheum Dis. 2010 Apr;69(4):631-7
references: 20215140
references: Med Decis Making. 2007 Mar-Apr;27(2):138-50
references: 17409364
references: Arthritis Rheum. 2008 Jan;58(1):15-25
references: 18163481
references: Arthritis Care Res (Hoboken). 2012 Feb;64(2):184-9
references: 22012868
references: Arthritis Rheum. 2007 Aug 15;57(6):928-34
references: 17665462
references: Arthritis Care Res (Hoboken). 2011 Jan;63(1):53-7
references: 20806274
references: Clin Rheumatol. 2011 Jan;30(1):103-6
references: 20683739
references: Arthritis Res Ther. 2013 Mar 18;15(2):R43
references: 23506671
references: Ann Rheum Dis. 2007 Jan;66(1):34-45
references: 16396980
references: Clin Ther. 2012 Feb;34(2):457-67
references: 22284901
references: Clin Exp Rheumatol. 2009 Jul-Aug;27(4 Suppl 55):S139-45
references: 19822061
references: Rheumatology (Oxford). 2007 Dec;46(12):1814-8
references: 18032538
references: Med Care. 2004 Sep;42(9):907-13
references: 15319617
references: Arthritis Rheum. 2007 Dec 15;57(8):1419-25
references: 18050182
references: JAMA. 2011 Feb 2;305(5):480-6
references: 21285425
references: Rheumatology (Oxford). 2000 Dec;39 Suppl 2:3-12
references: 11276800