title: Variability in the prescription of non-biologic disease-modifying antirheumatic drugs for the treatment of spondyloarthritis in Spain.
abstract: OBJECTIVE
  To describe the variability in the prescription of non-biologic disease-modifying antirheumatic drugs (nbDMARDs) for the treatment of spondyloarthritis (SpA) in Spain and to explore which factors relating to the disease, patient, physician, and/or center contribute to these variations.
  
  
  METHODS
  A retrospective medical record review was performed using a probabilistic sample of 1168 patients with SpA from 45 centers distributed in 15/19 regions in Spain. The sociodemographic and clinical features and the use of drugs were recorded following a standardized protocol. Logistic regression, with nbDMARDs prescriptions as the dependent variable, was used for bivariable analysis. A multilevel logistic regression model was used to study variability.
  
  
  RESULTS
  The probability of receiving an nbDMARD was higher in female patients [OR = 1.548; 95% confidence interval (CI): 1.208-1.984], in those with elevated C-reactive protein (OR = 1.039; 95% CI: 1.012-1.066) and erythrocyte sedimentation rate (OR = 1.012; 95% CI: 1.003-1.021), in those with a higher number of affected peripheral joints (OR = 12.921; 95% CI: 2.911-57.347), and in patients with extra-articular manifestations like dactylitis (OR = 2.997; 95% CI: 1.868-4.809), psoriasis (OR = 2.601; 95% CI: 1.870-3.617), and enthesitis (OR = 1.717; 95% CI: 1.224-2.410). There was a marked variability in the prescription of nbDMARDs for SpA patients, depending on the center (14.3%; variance 0.549; standard error 0.161; median odds ratio 2.366; p < 0.001). After adjusting for patient and center variables, this variability fell to 3.8%.
  
  
  CONCLUSIONS
  A number of factors affecting variability in clinical practice, and which are independent of disease characteristics, are associated with the probability of SpA patients receiving nbDMARDs in Spain.
authors.affiliation: Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Avenida da Residencia s/n, Ferrol, 15405, A Coruña, Spain. Electronic address: luciasilva@ser.es.
authors.forename: Lucía
authors.initials: L
authors.lastname: Silva-Fernández
authors.affiliation: Research Unit, Spanish Society for Rheumatology, Madrid, Spain.
authors.forename: Sabina
authors.initials: S
authors.lastname: Pérez-Vicente
authors.affiliation: Research Unit, Spanish Society for Rheumatology, Madrid, Spain.
authors.forename: María Auxiliadora
authors.initials: MA
authors.lastname: Martín-Martínez
authors.affiliation: Rheumatology Department, Complejo Hospitalario de Zamora, Zamora, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: López-González
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011565:Psoriasis / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013030:Spain; D025242:Spondylarthropathies / Q000150:complications / Q000188:drug therapy*; D012460:Sulfasalazine / Q000627:therapeutic use; D014605:Uveitis / Q000150:complications
chemical_list: D000962:Antimalarials; D018501:Antirheumatic Agents; D007555:Isoxazoles; D012460:Sulfasalazine; D016572:Cyclosporine; D003520:Cyclophosphamide; D000077339:Leflunomide; D001379:Azathioprine; D008727:Methotrexate
keywords: Disease-modifying antirheumatic drugs; Spondyloarthritis; Variability