Biologic and Glucocorticoid Use after Methotrexate Initiation in Patients with Rheumatoid Arthritis

Michael D. George, Brian C. Sauer, Chia Chen Teng, Grant W. Cannon, Bryant England, Gail S. Kerr, Ted R Mikuls, Joshua F. Baker

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: Biologic therapies can improve disease control for patients with rheumatoid arthritis (RA) but may be both overused and underused. We aimed to identify predictors of greater use of biologic therapies and to identify factors associated with persistent glucocorticoid use. METHODS: Using national US Veteran's Affairs databases 2005-2016, we identified patients with RA receiving a first-ever prescription of methotrexate (MTX), requiring ≥ 6 months of baseline data. We evaluated predictors of biologic therapy initiation within 2 years of starting MTX and factors associated with baseline and persistent glucocorticoid use at 6-12 months using multivariable models. RESULTS: Among 17,415 patients starting MTX, 3263 patients received biologic therapy within 2 years (20.6% 2-yr incidence). In adjusted analyses, biologic use was substantially lower in older patients [e.g., aHR 0.20 (95% CI 0.16, 0.26) for patients ≥ 80 vs < 50] and patients with more comorbidities [aHR 0.79 (95% CI 0.72, 0.87) for Charlson score ≥ 3 vs < 3]. Patients with heart failure [aHR 0.68 (95% CI 0.54, 0.84)], cancer [aHR 0.78 (95% CI 0.66, 0.92)], or who were nonwhite [aHR 0.79 (95% CI 0.72, 0.87)] were also less likely to receive a biologic. In contrast, baseline and persistent glucocorticoid use was similar across age groups and more common in patients with greater comorbidity. CONCLUSION: Biologic therapy is initiated less frequently in patients with RA who are older, have more comorbidities, and who are nonwhite. While biologics may be avoided in older and sicker patients because of safety concerns, glucocorticoid use is similar regardless of age and is more frequent in patients with comorbidities, with implications for patient outcomes.

Original languageEnglish (US)
Pages (from-to)343-350
Number of pages8
JournalThe Journal of rheumatology
Volume46
Issue number4
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

Fingerprint

Methotrexate
Glucocorticoids
Rheumatoid Arthritis
Biological Therapy
Comorbidity
United States Department of Veterans Affairs
Patient Safety
Biological Products
Prescriptions
Heart Failure
Age Groups
Databases

Keywords

  • BIOLOGICAL THERAPY
  • COMORBIDITY
  • GLUCOCORTICOIDS
  • PHYSICIANS’ PRACTICE PATTERNS
  • RHEUMATOID ARTHRITIS

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Biologic and Glucocorticoid Use after Methotrexate Initiation in Patients with Rheumatoid Arthritis. / George, Michael D.; Sauer, Brian C.; Teng, Chia Chen; Cannon, Grant W.; England, Bryant; Kerr, Gail S.; Mikuls, Ted R; Baker, Joshua F.

In: The Journal of rheumatology, Vol. 46, No. 4, 01.04.2019, p. 343-350.

Research output: Contribution to journalArticle

George, Michael D. ; Sauer, Brian C. ; Teng, Chia Chen ; Cannon, Grant W. ; England, Bryant ; Kerr, Gail S. ; Mikuls, Ted R ; Baker, Joshua F. / Biologic and Glucocorticoid Use after Methotrexate Initiation in Patients with Rheumatoid Arthritis. In: The Journal of rheumatology. 2019 ; Vol. 46, No. 4. pp. 343-350.
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AU - England, Bryant

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