Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice

Grant W. Cannon, Ted R Mikuls, Candace L. Hayden, Jian Ying, Jeffrey R. Curtis, Andreas M. Reimold, Liron Caplan, Gail S. Kerr, J. Steuart Richards, Dannette S. Johnson, Brian C. Sauer

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Objective. The Veterans Affairs (VA) Rheumatoid Arthritis (VARA) registry and the VA Pharmacy Benefits Management database were linked to determine the association of methotrexate (MTX) adherence with rheumatoid arthritis (RA) disease activity. Methods. For each patient, the medication possession ratio (MPR) was calculated for the first episode of MTX exposure of a duration of ≥12 weeks for both new and established MTX users. High MTX adherence was defined as an MPR ≥0.80 and low MTX adherence was defined as an MPR <0.80. For each patient, the mean Disease Activity Score with 28 joints (DAS28) score, erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) level observed during registry followup were compared in high-versus low-adherence groups. Results. In 455 RA patients, the prescribed doses of MTX (mean ± SD 16 ± 4 mg versus 16 ± 4 mg; P = 0.6) were similar in high-adherence patients (n = 370) in comparison to low-adherence patients (n = 85). However, the actual observed MTX doses taken by patients were significantly higher in the high-adherence group (mean ± SD 16 ± 5 mg versus 11 ± 3 mg; P < 0.001). DAS28 (mean ± SD 3.6 ± 1.2 versus 3.9 ± 1.5; P < 0.02), ESR (mean ± SD 24 ± 18 versus 29 ± 24 mm/hour; P = 0.05), and CRP level (mean ± SD 1.2 ± 1.3 versus 1.6 ± 1.5 mg/dl; P < 0.03) were lower in the high-adherence group compared to those with low MTX adherence. These variances were not explained by differences in baseline demographic features, concurrent treatments, or whether MTX was initiated before or after VARA enrollment. Conclusion. High MTX adherence was associated with improved clinical outcomes in RA patients treated with MTX. Adjustment for potential confounders did not alter the estimated effect of adherence. These results demonstrate the advantages of being able to merge clinical observations with pharmacy databases to evaluate antirheumatic drugs in clinical practice.

Original languageEnglish (US)
Pages (from-to)1680-1690
Number of pages11
JournalArthritis Care and Research
Volume63
Issue number12
DOIs
StatePublished - Dec 1 2011

Fingerprint

Veterans
Methotrexate
Registries
Rheumatoid Arthritis
Blood Sedimentation
Patient Compliance
Protein C
Joints
Databases
Antirheumatic Agents
Demography

ASJC Scopus subject areas

  • Rheumatology

Cite this

Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice. / Cannon, Grant W.; Mikuls, Ted R; Hayden, Candace L.; Ying, Jian; Curtis, Jeffrey R.; Reimold, Andreas M.; Caplan, Liron; Kerr, Gail S.; Richards, J. Steuart; Johnson, Dannette S.; Sauer, Brian C.

In: Arthritis Care and Research, Vol. 63, No. 12, 01.12.2011, p. 1680-1690.

Research output: Contribution to journalArticle

Cannon, GW, Mikuls, TR, Hayden, CL, Ying, J, Curtis, JR, Reimold, AM, Caplan, L, Kerr, GS, Richards, JS, Johnson, DS & Sauer, BC 2011, 'Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice', Arthritis Care and Research, vol. 63, no. 12, pp. 1680-1690. https://doi.org/10.1002/acr.20629
Cannon, Grant W. ; Mikuls, Ted R ; Hayden, Candace L. ; Ying, Jian ; Curtis, Jeffrey R. ; Reimold, Andreas M. ; Caplan, Liron ; Kerr, Gail S. ; Richards, J. Steuart ; Johnson, Dannette S. ; Sauer, Brian C. / Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice. In: Arthritis Care and Research. 2011 ; Vol. 63, No. 12. pp. 1680-1690.
@article{8f810bd4cdd84caeb1958aefdd626174,
title = "Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice",
abstract = "Objective. The Veterans Affairs (VA) Rheumatoid Arthritis (VARA) registry and the VA Pharmacy Benefits Management database were linked to determine the association of methotrexate (MTX) adherence with rheumatoid arthritis (RA) disease activity. Methods. For each patient, the medication possession ratio (MPR) was calculated for the first episode of MTX exposure of a duration of ≥12 weeks for both new and established MTX users. High MTX adherence was defined as an MPR ≥0.80 and low MTX adherence was defined as an MPR <0.80. For each patient, the mean Disease Activity Score with 28 joints (DAS28) score, erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) level observed during registry followup were compared in high-versus low-adherence groups. Results. In 455 RA patients, the prescribed doses of MTX (mean ± SD 16 ± 4 mg versus 16 ± 4 mg; P = 0.6) were similar in high-adherence patients (n = 370) in comparison to low-adherence patients (n = 85). However, the actual observed MTX doses taken by patients were significantly higher in the high-adherence group (mean ± SD 16 ± 5 mg versus 11 ± 3 mg; P < 0.001). DAS28 (mean ± SD 3.6 ± 1.2 versus 3.9 ± 1.5; P < 0.02), ESR (mean ± SD 24 ± 18 versus 29 ± 24 mm/hour; P = 0.05), and CRP level (mean ± SD 1.2 ± 1.3 versus 1.6 ± 1.5 mg/dl; P < 0.03) were lower in the high-adherence group compared to those with low MTX adherence. These variances were not explained by differences in baseline demographic features, concurrent treatments, or whether MTX was initiated before or after VARA enrollment. Conclusion. High MTX adherence was associated with improved clinical outcomes in RA patients treated with MTX. Adjustment for potential confounders did not alter the estimated effect of adherence. These results demonstrate the advantages of being able to merge clinical observations with pharmacy databases to evaluate antirheumatic drugs in clinical practice.",
author = "Cannon, {Grant W.} and Mikuls, {Ted R} and Hayden, {Candace L.} and Jian Ying and Curtis, {Jeffrey R.} and Reimold, {Andreas M.} and Liron Caplan and Kerr, {Gail S.} and Richards, {J. Steuart} and Johnson, {Dannette S.} and Sauer, {Brian C.}",
year = "2011",
month = "12",
day = "1",
doi = "10.1002/acr.20629",
language = "English (US)",
volume = "63",
pages = "1680--1690",
journal = "Arthritis and Rheumatism",
issn = "2151-4658",
publisher = "John Wiley and Sons Inc.",
number = "12",

}

TY - JOUR

T1 - Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice

AU - Cannon, Grant W.

AU - Mikuls, Ted R

AU - Hayden, Candace L.

AU - Ying, Jian

AU - Curtis, Jeffrey R.

AU - Reimold, Andreas M.

AU - Caplan, Liron

AU - Kerr, Gail S.

AU - Richards, J. Steuart

AU - Johnson, Dannette S.

AU - Sauer, Brian C.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Objective. The Veterans Affairs (VA) Rheumatoid Arthritis (VARA) registry and the VA Pharmacy Benefits Management database were linked to determine the association of methotrexate (MTX) adherence with rheumatoid arthritis (RA) disease activity. Methods. For each patient, the medication possession ratio (MPR) was calculated for the first episode of MTX exposure of a duration of ≥12 weeks for both new and established MTX users. High MTX adherence was defined as an MPR ≥0.80 and low MTX adherence was defined as an MPR <0.80. For each patient, the mean Disease Activity Score with 28 joints (DAS28) score, erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) level observed during registry followup were compared in high-versus low-adherence groups. Results. In 455 RA patients, the prescribed doses of MTX (mean ± SD 16 ± 4 mg versus 16 ± 4 mg; P = 0.6) were similar in high-adherence patients (n = 370) in comparison to low-adherence patients (n = 85). However, the actual observed MTX doses taken by patients were significantly higher in the high-adherence group (mean ± SD 16 ± 5 mg versus 11 ± 3 mg; P < 0.001). DAS28 (mean ± SD 3.6 ± 1.2 versus 3.9 ± 1.5; P < 0.02), ESR (mean ± SD 24 ± 18 versus 29 ± 24 mm/hour; P = 0.05), and CRP level (mean ± SD 1.2 ± 1.3 versus 1.6 ± 1.5 mg/dl; P < 0.03) were lower in the high-adherence group compared to those with low MTX adherence. These variances were not explained by differences in baseline demographic features, concurrent treatments, or whether MTX was initiated before or after VARA enrollment. Conclusion. High MTX adherence was associated with improved clinical outcomes in RA patients treated with MTX. Adjustment for potential confounders did not alter the estimated effect of adherence. These results demonstrate the advantages of being able to merge clinical observations with pharmacy databases to evaluate antirheumatic drugs in clinical practice.

AB - Objective. The Veterans Affairs (VA) Rheumatoid Arthritis (VARA) registry and the VA Pharmacy Benefits Management database were linked to determine the association of methotrexate (MTX) adherence with rheumatoid arthritis (RA) disease activity. Methods. For each patient, the medication possession ratio (MPR) was calculated for the first episode of MTX exposure of a duration of ≥12 weeks for both new and established MTX users. High MTX adherence was defined as an MPR ≥0.80 and low MTX adherence was defined as an MPR <0.80. For each patient, the mean Disease Activity Score with 28 joints (DAS28) score, erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) level observed during registry followup were compared in high-versus low-adherence groups. Results. In 455 RA patients, the prescribed doses of MTX (mean ± SD 16 ± 4 mg versus 16 ± 4 mg; P = 0.6) were similar in high-adherence patients (n = 370) in comparison to low-adherence patients (n = 85). However, the actual observed MTX doses taken by patients were significantly higher in the high-adherence group (mean ± SD 16 ± 5 mg versus 11 ± 3 mg; P < 0.001). DAS28 (mean ± SD 3.6 ± 1.2 versus 3.9 ± 1.5; P < 0.02), ESR (mean ± SD 24 ± 18 versus 29 ± 24 mm/hour; P = 0.05), and CRP level (mean ± SD 1.2 ± 1.3 versus 1.6 ± 1.5 mg/dl; P < 0.03) were lower in the high-adherence group compared to those with low MTX adherence. These variances were not explained by differences in baseline demographic features, concurrent treatments, or whether MTX was initiated before or after VARA enrollment. Conclusion. High MTX adherence was associated with improved clinical outcomes in RA patients treated with MTX. Adjustment for potential confounders did not alter the estimated effect of adherence. These results demonstrate the advantages of being able to merge clinical observations with pharmacy databases to evaluate antirheumatic drugs in clinical practice.

UR - http://www.scopus.com/inward/record.url?scp=84863049921&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863049921&partnerID=8YFLogxK

U2 - 10.1002/acr.20629

DO - 10.1002/acr.20629

M3 - Article

C2 - 21905260

AN - SCOPUS:84863049921

VL - 63

SP - 1680

EP - 1690

JO - Arthritis and Rheumatism

JF - Arthritis and Rheumatism

SN - 2151-4658

IS - 12

ER -