title: Inconsistent treatment with disease-modifying antirheumatic drugs: a longitudinal data analysis.
abstract: OBJECTIVE
  Current recommendations advocate treatment with disease-modifying antirheumatic drugs (DMARD) in all patients with active rheumatoid arthritis (RA). We investigated the frequency of and reasons for inconsistent DMARD use among patients in a clinical rheumatology cohort.
  
  
  METHODS
  Patients in the Brigham Rheumatoid Arthritis Sequential Study were studied for DMARD use (any or none) at each semiannual study timepoint during the first 2 study years. Inconsistent use was defined as DMARD use at ≤ 40% of study timepoints. Characteristics were compared between inconsistent and consistent users (> 40%), and factors associated with inconsistent DMARD use were determined through multivariate logistic regression. A medical record review was performed to determine the reasons for inconsistent use.
  
  
  RESULTS
  Of 848 patients with ≥ 4 out of 5 visits recorded, 55 (6.5%) were inconsistent DMARD users. Higher age, longer disease duration, and rheumatoid factor negativity were statistically significant correlates of inconsistent use in the multivariate analyses. The primary reasons for inconsistent use identified through chart review, allowing for up to 2 co-primary reasons, were inactive disease (n = 28, 50.9%), intolerance to DMARD (n = 18, 32.7%), patient preference (n = 7, 12.7%), comorbidity (n = 6, 10.9%), DMARD not being effective (n = 3, 5.5%), and pregnancy (n = 3, 5.5%). During subsequent followup, 14/45 (31.1%) inconsistent users with sufficient data became consistent users of DMARD.
  
  
  CONCLUSIONS
  A small proportion of patients with RA in a clinical rheumatology cohort were inconsistent DMARD users during the first 2 years of followup. While various patient factors correlate with inconsistent use, many patients re-start DMARD and become consistent users over time.
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital. maria_mjaavatten@hotmail.com.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Mjaavatten
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Helga
authors.initials: H
authors.lastname: Radner
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Shadick
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Frits
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Iannaccone
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Weinblatt
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, and the Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.M.D. Mjaavatten, MD, PhD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; H. Radner, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; K. Yoshida, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Rheumatology, Kameda Medical Center; N.A. Shadick, MD, MPH; M.L. Frits, BA; C.K. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; M.E. Weinblatt, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, and Immunology and Allergy, and Division of Pharmacoepidemiology, Brigham and Women's Hospital.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D012217:Rheumatoid Factor
keywords: DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; DRUG ADHERENCE; LONGITUDINAL STUDIES; RHEUMATOID ARTHRITIS