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Three Trends in RA Treatment of Note

The use of DMARDs are up prior to starting a biologic as is the use of biologics in patients never before prescribed DMARDS.

With changes in rheumatoid arthritis treatment in recent decades, including the development of biologic agents, how has this impacted disease management? That’s the question that motivated researchers in this study, presented by James R. O'Dell of the University of Nebraska Medical Center ON Nov. 16 at the American College of Rheumatology annual meeting in Washington, D.C.

The study looked at the use of biologic agents as a patient’s first disease-modifying antirheumatic drug treatment type, in addition to those using subcutaneously administered methotrexate after trying oral methotrexate.

Researchers investigated two patient groups:  one starting treatment with a biologic agent in 2009 or 2012, and one group using used subcutaneously administered methotrexate subsequent to an oral drug trial in same two time periods. The patient-level claims data came from Symphony Health Solutions, which covers 92% of all U.S. prescription drugs dispensed, and around 274 million patients. Researchers identified patients for the study via ICD-9 codes 714.0 and 714.30. They followed the claims data for both groups through 2014. They also considered the patients’ treatment in the one year prior.

The 2009 cohort included 48,910 patients, while the 2012 cohort had 107,536 patients. The 2009 group included 13,270 patients (27.1%) who started their treatment with a biologic agent, compared with 38,209 (35.6%) for the 2012 group. Researchers did not find that these two subgroups had different clinical characteristics or baseline demographics.

The researchers concluded that the 2012 group used subcutaneously administered methotrexate at a significantly higher rate than the 2009 group. In the 2009 cohort, 35,640 patients started with oral methotrexate, with 20,041 of them (56.2%) changing to another treatment during the next five years. Of patients who stopped using oral methotrexate, 2,513 (12.5%) started on subcutaneously administered methotrexate. In the 2012 cohort, 69,327 patients started on oral methotrexate, with 18,989 (27.4%) changing treatments during the next two years. From that group, 3,976 (20.9%) changed to subcutaneously administered methotrexate.

Researchers found three trends in rheumatoid arthritis treatment, from their study. The first is an increasing use of non-methotrexate agents as a disease-modifying antirheumatic drug, before starting a biologic. They also found increasing use of biologics without the patients previously using conventional DMARDs. The third finding was a non-optimal increase in the use of subcutaneously administered methotrexate after using oral methotrexate.


Dr. O’Dell and the study co-authors have ties with Medac Pharma, Antares, Eli Lilly and Company, Abbvie, Bristol-Myers Squibb, Amgen, AstraZeneca, Centocor, Inc., Celgene, Genzyme Corporation, Hospira, Pfizer Inc, Roche Pharmaceuticals and Novartis Pharmaceutical Corporation.


"Rheumatoid Arthritis (RA): Premature Use of Biologics Accelerating in United States (US)," James R. O'Dell. Abstract 3152. 9:45 a.m., Nov. 16, 2016. ACR/ARHP 2016 Annual Meeting.