Timing and Impact of Decisions to Adjust Disease-Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease

Yomei Shaw, Chung Chou H. Chang, Marc C. Levesque, Julie M. Donohue, Kaleb D Michaud, Mark S. Roberts

Research output: Contribution to journalArticle

Abstract

Objective: Guidelines recommend that rheumatoid arthritis (RA) patients with moderate-to-high disease activity (MHDAS) adjust disease-modifying antirheumatic drug (DMARD) therapy at least every 3 months until reaching low disease activity or remission (LDAS). We examined how quickly RA patients with MHDAS adjust DMARD therapy in clinical practice, and whether those who adjust DMARDs within 90 days in response to MHDAS reach LDAS sooner. Methods: We identified RA patients with MHDAS in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research registry, and conducted a competing risks regression on time to DMARD therapy adjustment and a Cox regression on time to LDAS. Results: We identified 538 eligible subjects with 943.5 patient-years of followup. Sixty percent of patients with persistent MHDAS adjusted DMARDs within 90 days. Among all subjects, median times to DMARD adjustment and LDAS were 154 (interquartile range [IQR] 1–706) days and 301 (IQR 140–706) days, respectively. Being elderly (subdistribution hazard ratio [SHR] 0.61, P = 0.02), lower baseline disease activity (SHR 0.72, P < 0.01), longer duration of RA (SHR 0.98, P < 0.01), and biologic use (SHR 0.71, P < 0.01) were significantly associated with longer times to therapy adjustment. African American race (hazard ratio [HR] 0.63, P = 0.01), higher baseline disease activity (HR 0.75, P < 0.01), and not adjusting DMARD therapy within 90 days (HR 0.76, P = 0.01) were associated with longer times to LDAS. Conclusion: Adjusting DMARDs within 90 days was associated with shorter times to LDAS, but many patients with persistent MHDAS waited >90 days to adjust DMARDs. Interventions are needed to address the timeliness of DMARD adjustments for RA patients with MHDAS.

Original languageEnglish (US)
Pages (from-to)834-841
Number of pages8
JournalArthritis Care and Research
Volume70
Issue number6
DOIs
StatePublished - Jun 1 2018

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Antirheumatic Agents
Rheumatoid Arthritis
Drug Therapy
Comparative Effectiveness Research
Registries
Guidelines

ASJC Scopus subject areas

  • Rheumatology

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Timing and Impact of Decisions to Adjust Disease-Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease. / Shaw, Yomei; Chang, Chung Chou H.; Levesque, Marc C.; Donohue, Julie M.; Michaud, Kaleb D; Roberts, Mark S.

In: Arthritis Care and Research, Vol. 70, No. 6, 01.06.2018, p. 834-841.

Research output: Contribution to journalArticle

Shaw, Yomei ; Chang, Chung Chou H. ; Levesque, Marc C. ; Donohue, Julie M. ; Michaud, Kaleb D ; Roberts, Mark S. / Timing and Impact of Decisions to Adjust Disease-Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 6. pp. 834-841.
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