Rheumatoid arthritis and DMARDs

Rheuma­toid arthri­tis and DMARDs

Quote from Clin­i­cal trial: Con­tem­po­rary dis­ease mod­i­fy­ing antirheumatic drugs (DMARD) in patients with recent onset rheuma­toid arthri­tis in a US pri­vate prac­tice: methotrex­ate as the anchor drug in 90% and new DMARD in 30% of patients.

OBJECTIVE: To describe ther­a­pies with dis­ease mod­i­fy­ing antirheumatic drugs (DMARD) and bio­log­i­cal agents in patients with early rheuma­toid arthri­tis (RA) who were receiv­ing rou­tine clin­i­cal care in 2001 in a pri­vate prac­tice of 5 rheuma­tol­o­gists in Nashville, TN, USA. METHODS: A cohort of 232 patients with ini­tial symp­toms of RA in 1998 or later were enrolled between Feb­ru­ary and Octo­ber 2001 into a longterm obser­va­tional study, designed to eval­u­ate treat­ments and longterm out­comes of RA. The base­line eval­u­a­tion included review of all DMARD that had been taken since dis­ease onset, clin­i­cal mea­sures on a mul­ti­di­men­sional health assess­ment ques­tion­naire, joint counts, and lab­o­ra­tory mea­sures. RESULTS: Among the 232 patients, methotrex­ate (MTX) was the first DMARD used in 192 patients (82.8%), includ­ing 3 in com­bi­na­tions. Since ini­ti­a­tion of the first DMARD to the study visit, over a median inter­val of 12.1 months, 125 (66.1%) patients of the 189 whose ini­tial DMARD was MTX as a sin­gle DMARD con­tin­ued MTX as a sin­gle DMARD, 43 (22.8%) had another DMARD or bio­log­i­cal agent added in com­bi­na­tion with MTX, and 21 (11.1%) dis­con­tin­ued MTX. Since the onset of RA, 89.2% of the patients had taken MTX, 15.9% hydrox­y­chloro­quine, 3.9% sul­fasalazine, 22.0% lefluno­mide, 9.5% etan­er­cept, 4.3 inflix­imab, and 87.0% pred­nisone. CONCLUSION: After a median dura­tion of 12.1 months of DMARD ther­apy, almost 90% of patients with recent onset RA took MTX as the anchor drug. More than 60% took MTX as a sin­gle DMARD or in com­bi­na­tion with tra­di­tional DMARD, while 30% took lefluno­mide, etan­er­cept, or inflix­imab, usu­ally in com­bi­na­tion with MTX.

My opin­ion methotrex­ate (MTX) is most pop­u­lar drug in   Rheuma­toid arthritis.

Con­clu­sions. When choos­ing DMARD monother­apy in early RA, rheuma­tol­o­gists in ERAN seem to pref­er­en­tially pre­scribe MTX for patients with a poor prog­no­sis and SSZ for patients with good prog­no­sis. No DMARDs were used in older patients or in those with a low HAQ.

KEY WORDS: Rheuma­toid arthri­tis, DMARD choice, Prog­nos­tic factors

Methotrex­ate has dis­placed other DMARDs, espe­cially sul­phasalazine, as agent of first choice and newer agents have dis­placed older DMARDs. Whether the expressed pref­er­ence for par­tic­u­lar DMARDs accu­rately reflects actual use, and is opti­mal in rheuma­toid arthri­tis, remains to be deter­mined.

KEY WORDS: Sur­vey, DMARD, Pre­scrib­ing pref­er­ence, Rheuma­tol­o­gists, Rheuma­toid arthri­tis.