Disease modifying anti-rheumatic drugs, biologics and corticosteroid use in older patients with rheumatoid arthritis over 20 years

2020 ◽  
pp. jrheum.200310
Author(s):  
John G. Hanly ◽  
Lynn Lethbridge

Objective To examine changes in prescribing patterns, especially the use of corticosteroids, in patients with rheumatoid arthritis (RA) over two decades. Methods This was a secondary analysis of health administrative data using a previously validated dataset and case definition for RA. Cases were matched 1:4 by age and sex to controls within a population of approximately 1 million inhabitants with access to universal health care. Longitudinal data for incident and prevalent RA cases were studied between 1997 and 2017. Results There were 8240 RA cases (all ≥ 65 years) with a mean (SD) age 72.2 (7.5) years and 70.6% were female. Over 20 years, annual utilization of coxibs in prevalent RA cases fell with a concomitant increase in disease modifying anti-rheumatic drugs (DMARDs) and biologics. Over the same period corticosteroid use was largely unchanged. Approximately one third of patients had at least one annual prescription for corticosteroid, most frequently prednisone. The mean annual dose showed a modest reduction and the duration of utilization in each year shortened. Rheumatologists prescribed corticosteroids less frequently and in lower doses than other physician groups. For incident RA cases there was a significant fall in annual prescribed dose of prednisone by rheumatologists over time. Conclusion In older adults with RA the utilization of DMARDs and biologics has increased over the past 20 years. However, the use of corticosteroids has persisted. Renewed efforts are required to minimize their use in the long-term pharmacological management of RA.

2004 ◽  
Vol 50 (5) ◽  
pp. 1390-1399 ◽  
Author(s):  
Robert Landewé ◽  
Piet Geusens ◽  
Maarten Boers ◽  
Désirée van der Heijde ◽  
Willem Lems ◽  
...  

2013 ◽  
Vol 6 ◽  
pp. CMAMD.S5558 ◽  
Author(s):  
Pradeep Kumar ◽  
Snehashish Banik

Drugs form the mainstay of therapy in rheumatoid arthritis (RA). Five main classes of drugs are currently used: analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, nonbiologic and biologic disease-modifying antirheumatic drugs. Current clinical practice guidelines recommend that clinicians start biologic agents if patients have suboptimal response or intolerant to one or two traditional disease modifying agents (DMARDs). Methotrexate, sulfasalazine, leflunomide and hydroxychloroquine are the commonly used DMARDs. Currently, anti-TNF is the commonly used first line biologic worldwide followed by abatacept and it is usually combined with MTX. There is some evidence that tocilizumab is the most effective biologic as a monotherapy agent. Rituximab is generally not used as a first line biologic therapy due to safety issues but still as effective as anti-TNF. The long term data for the newer oral small molecule biologics such as tofacitinib is not available and hence used only as a last resort.


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