Predictors of stopping and starting disease-modifying antirheumatic drugs for rheumatoid arthritis.
OBJECTIVE
Disease-modifying antirheumatic drugs (DMARDs) are the standard of care for rheumatoid arthritis (RA); however, studies have found that many patients do not receive them. We examined predictors of starting and stopping DMARDs among a longitudinal cohort of patients with RA.


METHODS
Study participants came from a cohort of RA patients recruited from a random sample of rheumatologists' practices in Northern California. We examined patterns and predictors of stopping and starting nonbiologic and biologic DMARDs during 1982-2009 based on annual questionnaires. Stopping was defined as stopping all DMARDs and starting was defined as transitioning from no DMARDs to any DMARDs across 2 consecutive years.


RESULTS
The analysis of starting DMARDs included 471 subjects with 1,974 pairs of years with no DMARD use in the first of 2 consecutive years. From this population, subjects started DMARD use by year 2 in 313 (15.9%) of the pairs. The analysis of stopping DMARDs included 1,026 subjects with 7,595 pairs of years with DMARD use in the first of 2 consecutive years; in 423 pairs (5.6%), subjects stopped DMARD use by year 2. In models that adjusted for RA-related factors, sociodemographics, and comorbidities, significant predictors of starting DMARDs included younger age, Hispanic ethnicity, shorter disease duration, and the use of oral glucocorticoids. In separate adjusted models, predictors of stopping DMARDs included Hispanic ethnicity and low income, while younger age was associated with a reduced risk of stopping.


CONCLUSIONS
Efforts to improve DMARD use should focus on patient age, ethnicity, and income and RA-related factors.
Brigham and Women's Hospital, Boston, Massachusetts.
Daniel H
DH
Solomon
Chris
C
Tonner
Bing
B
Lu
Seoyoung C
SC
Kim
John Z
JZ
Ayanian
M Alan
MA
Brookhart
Jeffrey N
JN
Katz
Ed
E
Yelin
D000328:Adult; D000367:Age Factors; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D028761:Withholding Treatment; D016903:Drug Monitoring
D018501:Antirheumatic Agents