Physician preference motivates the use of anti–tumor necrosis factor therapy independent of clinical disease activity

Authors

  • Jeffrey R. Curtis,

    Corresponding author
    1. Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham
    • University of Alabama at Birmingham, 076 Spain Rehabilitation Center, 1717 6th Avenue South, Birmingham, AL 35294-7201
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    • Dr. Curtis has received consultant/advisory board and/or speaking fees from Procter & Gamble, Amgen, Centocor, Eli Lilly, and Merck (less than $10,000 each), and from UCB, Roche, Consortium of Rheumatology Researchers of North America, and Novartis (more than $10,000 each), and research grants from Merck, Procter & Gamble, Eli Lilly, Roche, Centocor, Consortium of Rheumatology Researchers of North America, Amgen, and Novartis.

  • Lang Chen,

    1. Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham
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  • Leslie R. Harrold,

    1. University of Massachusetts Medical School, Worcester
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  • Pongthorn Narongroeknawin,

    1. Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham
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  • George Reed,

    1. University of Massachusetts Medical School, Worcester
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  • Daniel H. Solomon

    1. Brigham and Women's Hospital, Boston, Massachusetts
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    • Dr. Solomon has received research grants from Amgen and Abbott.


Abstract

Objective

Physician preference has previously been shown to be an important determinant of prescription patterns, independent of patient-specific factors. We evaluated whether physician preference was important in the decision to select anti–tumor necrosis factor (anti-TNF) therapy rather than nonbiologic disease-modifying antirheumatic drugs (DMARDs) among rheumatoid arthritis (RA) patients initiating a new RA medication.

Methods

Using data from the Consortium of Rheumatology Researchers of North America, we identified RA patients who had never taken biologics initiating either anti-TNF therapy or a DMARD in 2001–2008. Physician preference for the use of anti-TNF agents was calculated using data from the preceding calendar year for each physician's other RA patients. Multivariable logistic regression with generalized estimating equations accounted for clustering of patients within the physician practice and evaluated the relationship between physician preference and receipt of anti-TNF therapy, controlling for patient-related factors and disease activity using the Clinical Disease Activity Index.

Results

We identified 1,532 RA patients initiating anti-TNF therapy or a DMARD. In models adjusting for tender and swollen joint counts and global disease activity, physician preference for the use of anti-TNF therapy was an independent predictor of receipt of these agents. Patients of physicians in the highest and middle tertiles of physician preference had a 2.50 (95% confidence interval [95% CI] 1.76–3.56) and 1.70 (95% CI 1.22–2.39) greater likelihood of receiving anti-TNF medications, respectively.

Conclusion

Physician preference is an important determinant of patients' receipt of anti-TNF therapy and may be useful to examine in future studies of RA treatment patterns, costs, and medication safety.

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