Underuse of Methotrexate in the Treatment of Rheumatoid Arthritis: A National Analysis of Prescribing Practices in the US

Melanie K. Rohr, Ted R Mikuls, Stanley B. Cohen, J. Carter Thorne, James Robert O'Dell

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Abstract

Objective: Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) due to its effectiveness, tolerability, and cost. This study examines MTX prescribing practices in the US from 2009 to 2014. Methods: Symphony Health Solutions, which covers 274 million patients in the US, was used to identify patients diagnosed with RA who were naive to MTX in 2009 and 2012. Data were collected, including medication use and doses, demographics, and medical comorbidities. Results: Of the patients who had 5-year followup data available, oral MTX was started in 35,640 in 2009, and 44% continued taking this dose during the followup. Of the 20,041 patients who changed therapy during the study period, 87% had the addition of or switched to a biologic agent, while 13% were changed from oral to subcutaneous (SC) MTX. The mean oral dose prior to the start of a biologic agent was 15.3 ± 5 mg/week. A comparison of 2009 with 2012 showed a modest increase in the mean dose of oral MTX from 15.3 mg/week to 15.9 mg/week, as well as a small but statistically significant (P < 0.0001) increase in the use of SC MTX after failure of oral MTX from 13% to 16% of patients. Conclusion: MTX is underutilized in the treatment of RA with suboptimal dosing, inadequate duration of therapy, and failure to use SC administration. The comparison of MTX use between the 2009 and the 2012 cohorts demonstrates only a marginal increase in the dose of oral MTX and the use of SC MTX.

Original languageEnglish (US)
Pages (from-to)794-800
Number of pages7
JournalArthritis Care and Research
Volume69
Issue number6
DOIs
StatePublished - Jun 2017

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Methotrexate
Rheumatoid Arthritis
Therapeutics
Biological Factors
Cost-Benefit Analysis
Comorbidity
Demography

ASJC Scopus subject areas

  • Rheumatology

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Underuse of Methotrexate in the Treatment of Rheumatoid Arthritis : A National Analysis of Prescribing Practices in the US. / Rohr, Melanie K.; Mikuls, Ted R; Cohen, Stanley B.; Thorne, J. Carter; O'Dell, James Robert.

In: Arthritis Care and Research, Vol. 69, No. 6, 06.2017, p. 794-800.

Research output: Contribution to journalArticle

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abstract = "Objective: Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) due to its effectiveness, tolerability, and cost. This study examines MTX prescribing practices in the US from 2009 to 2014. Methods: Symphony Health Solutions, which covers 274 million patients in the US, was used to identify patients diagnosed with RA who were naive to MTX in 2009 and 2012. Data were collected, including medication use and doses, demographics, and medical comorbidities. Results: Of the patients who had 5-year followup data available, oral MTX was started in 35,640 in 2009, and 44{\%} continued taking this dose during the followup. Of the 20,041 patients who changed therapy during the study period, 87{\%} had the addition of or switched to a biologic agent, while 13{\%} were changed from oral to subcutaneous (SC) MTX. The mean oral dose prior to the start of a biologic agent was 15.3 ± 5 mg/week. A comparison of 2009 with 2012 showed a modest increase in the mean dose of oral MTX from 15.3 mg/week to 15.9 mg/week, as well as a small but statistically significant (P < 0.0001) increase in the use of SC MTX after failure of oral MTX from 13{\%} to 16{\%} of patients. Conclusion: MTX is underutilized in the treatment of RA with suboptimal dosing, inadequate duration of therapy, and failure to use SC administration. The comparison of MTX use between the 2009 and the 2012 cohorts demonstrates only a marginal increase in the dose of oral MTX and the use of SC MTX.",
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T2 - A National Analysis of Prescribing Practices in the US

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AU - Cohen, Stanley B.

AU - Thorne, J. Carter

AU - O'Dell, James Robert

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N2 - Objective: Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) due to its effectiveness, tolerability, and cost. This study examines MTX prescribing practices in the US from 2009 to 2014. Methods: Symphony Health Solutions, which covers 274 million patients in the US, was used to identify patients diagnosed with RA who were naive to MTX in 2009 and 2012. Data were collected, including medication use and doses, demographics, and medical comorbidities. Results: Of the patients who had 5-year followup data available, oral MTX was started in 35,640 in 2009, and 44% continued taking this dose during the followup. Of the 20,041 patients who changed therapy during the study period, 87% had the addition of or switched to a biologic agent, while 13% were changed from oral to subcutaneous (SC) MTX. The mean oral dose prior to the start of a biologic agent was 15.3 ± 5 mg/week. A comparison of 2009 with 2012 showed a modest increase in the mean dose of oral MTX from 15.3 mg/week to 15.9 mg/week, as well as a small but statistically significant (P < 0.0001) increase in the use of SC MTX after failure of oral MTX from 13% to 16% of patients. Conclusion: MTX is underutilized in the treatment of RA with suboptimal dosing, inadequate duration of therapy, and failure to use SC administration. The comparison of MTX use between the 2009 and the 2012 cohorts demonstrates only a marginal increase in the dose of oral MTX and the use of SC MTX.

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