title: Treatment Patterns of Multimorbid Patients with Rheumatoid Arthritis: Results from an International Cross-sectional Study.
abstract: OBJECTIVE
  To describe the treatment profile of multimorbid patients with rheumatoid arthritis (RA) in contrast to patients with RA only.
  
  
  METHODS
  COMORA (Comorbidities in Rheumatoid Arthritis) is a cross-sectional, international study assessing morbidities, outcomes, and treatment of patients with RA. Patients were grouped according to their multimorbidity profile assessed by a counted multimorbidity index (cMMI). Treatment for RA was categorized as use of biologic disease-modifying antirheumatic drugs (bDMARD), in particular tumor necrosis factor inhibitors (TNFi), synthetic DMARD (sDMARD) use only, nonsteroidal antiinflammatory drug (NSAID) use, and corticosteroid use. Logistic regression models were performed to determine the OR of bDMARD, TNFi, sDMARD, NSAID, or corticosteroid use based on a patient's cMMI and global region after adjusting for age, disease activity, disease duration, educational level, and previous DMARD therapy.
  
  
  RESULTS
  Out of 3920 patients, 32.7% received bDMARD; 59.9% sDMARD only, 51.1% used concomitant NSAID, and 54.8% used corticosteroid. Regional differences were observed with the most frequent use of bDMARD in the United States (46.5%) and lowest in North Africa (9%). After adjusting for confounders in logistic regression, the OR for bDMARD use was reduced for each additional morbidity (OR 0.89, 95% CI 0.83-0.96). Similar results were found for TNFi (OR 0.91, 95% CI 0.84-0.99), whereas the OR for use of sDMARD was increased (1.13, 95% CI 1.05-1.22). No significant change of OR was found for NSAID or corticosteroid use.
  
  
  CONCLUSIONS
  In this study, the odds of bDMARD use decreases 11% for each additional chronic morbid condition after adjustment for regional differences, disease activity, and other covariates.
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco; Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.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, MPH, Department of Epidemiology, Harvard School of Public Health; I. Hmamouchi, MD, PhD, Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, LBRCE; M. Dougados, MD, Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; J.S. Smolen, MD, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital. hradner@partners.org.
authors.forename: Helga
authors.initials: H
authors.lastname: Radner
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco; Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.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, MPH, Department of Epidemiology, Harvard School of Public Health; I. Hmamouchi, MD, PhD, Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, LBRCE; M. Dougados, MD, Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; J.S. Smolen, MD, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco; Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.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, MPH, Department of Epidemiology, Harvard School of Public Health; I. Hmamouchi, MD, PhD, Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, LBRCE; M. Dougados, MD, Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; J.S. Smolen, MD, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
authors.forename: Ihsane
authors.initials: I
authors.lastname: Hmamouchi
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco; Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.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, MPH, Department of Epidemiology, Harvard School of Public Health; I. Hmamouchi, MD, PhD, Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, LBRCE; M. Dougados, MD, Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; J.S. Smolen, MD, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco; Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.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, MPH, Department of Epidemiology, Harvard School of Public Health; I. Hmamouchi, MD, PhD, Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, LBRCE; M. Dougados, MD, Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; J.S. Smolen, MD, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.affiliation: From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria; Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco; Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France.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, MPH, Department of Epidemiology, Harvard School of Public Health; I. Hmamouchi, MD, PhD, Mohammed V Souissi University, Faculty of Medicine, Laboratory of Biostatistics, LBRCE; M. Dougados, MD, Paris Descartes University, Department of Rheumatology - Hôpital Cochin, Assistance Publique Hôpitaux de Paris, EULAR center of excellence, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; J.S. Smolen, MD, Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna; D.H. Solomon, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: MULTIMORBIDITY; RHEUMATOID ARTHRITIS; TREATMENT PATTERN