Lack of complete and consistent adherence to DMARD regimens may not be as adverse to outcomes as you think.
Mjaavatten MD, Radner H, Yoshida K, et al., Do rheumatologists know best? An outcomes study of inconsistent users of disease-modifying anti-rheumatic drugs. Semin Arthritis Rheum. (2014) Aug 27. pii: S0049-0172(14)00185-1. doi: 10.1016/j.semarthrit.2014.08.003. [Epub ahead of print]
Disease activity, joint damage, physical functioning, and quality of life don’t appear to be affected – at least in the short term – among patients who take their medications inconsistently, according to a large RA registry study.
The study, examining disease-modifying anti-rheumatic drug (DMARD) use patterns in 617 patients from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS), finds that outcomes at two and three years are not appreciably affected by uneven DMARD use.
That’s not to say further studies won’t reveal negative impacts with inconsistent use of DMARDs, the researchers caution, but the present study does reflect real-world clinical conditions as opposed to a clinical trial setting.
Current recommendations are that all patients with active RA be treated early and aggressively with DMARDs, targeting remission or low disease activity.
Primary outcomes in the study include improvements in Disease Activity Score 28-C Reactive Protein (DAS28-CRP), changes in the Modified Health Assessment Questionnaire (MHAQ), and radiographic progression.
There were no significant differences in these outcomes among patients asked whether or not they were taking their medications at different four time points during the first 18 months of the study. or in health-related quality (HRQoL) of life at 24 months.
There was evidence of a linear trend for worse outcomes in two HRQoL scales -- the Short Form Health Survey-12 physical summary scores (SF-12PCS) and the EuroQol 5-Dimensional health index (EQ-5D) -- among seropositive patients who were inconsistent DMARD users. There was also a linear trend at 36 months for higher DAS28-CRP scores for inconsistent users of DMARDs, the researchers report.
The majority of patients were women (mean age 57) who’d had RA for around 14 years.
As in a previous study by the same researchers, inconsistent DMARD use seemed to be associated with older age, longer disease duration, and seronegative status (rheumatoid factor and anti-cyclic citrullinated peptides).