Dr. Solomon receives salary support from research grants to his institution from Amgen, the Consortium of Rheumatology Researchers of North America, Eli Lilly, and Pfizer, and has served in unpaid roles on trials funded by Pfizer, Eli Lilly, and Novartis.
Predictors of Stopping and Starting Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis
Version of Record online: 28 JUL 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 8, pages 1152–1158, August 2014
How to Cite
Solomon, D. H., Tonner, C., Lu, B., Kim, S. C., Ayanian, J. Z., Brookhart, M. A., Katz, J. N. and Yelin, E. (2014), Predictors of Stopping and Starting Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis. Arthritis Care Res, 66: 1152–1158. doi: 10.1002/acr.22286
- Issue online: 28 JUL 2014
- Version of Record online: 28 JUL 2014
- Accepted manuscript online: 27 JAN 2014 01:52PM EST
- Manuscript Accepted: 14 JAN 2014
- Manuscript Received: 3 APR 2013
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Numbers: R01-AR-056215, K24-AR-055989, P60-AR-047782, K23-AR-059677
Disease-modifying antirheumatic drugs (DMARDs) are the standard of care for rheumatoid arthritis (RA); however, studies have found that many patients do not receive them. We examined predictors of starting and stopping DMARDs among a longitudinal cohort of patients with RA.
Study participants came from a cohort of RA patients recruited from a random sample of rheumatologists' practices in Northern California. We examined patterns and predictors of stopping and starting nonbiologic and biologic DMARDs during 1982–2009 based on annual questionnaires. Stopping was defined as stopping all DMARDs and starting was defined as transitioning from no DMARDs to any DMARDs across 2 consecutive years.
The analysis of starting DMARDs included 471 subjects with 1,974 pairs of years with no DMARD use in the first of 2 consecutive years. From this population, subjects started DMARD use by year 2 in 313 (15.9%) of the pairs. The analysis of stopping DMARDs included 1,026 subjects with 7,595 pairs of years with DMARD use in the first of 2 consecutive years; in 423 pairs (5.6%), subjects stopped DMARD use by year 2. In models that adjusted for RA-related factors, sociodemographics, and comorbidities, significant predictors of starting DMARDs included younger age, Hispanic ethnicity, shorter disease duration, and the use of oral glucocorticoids. In separate adjusted models, predictors of stopping DMARDs included Hispanic ethnicity and low income, while younger age was associated with a reduced risk of stopping.
Efforts to improve DMARD use should focus on patient age, ethnicity, and income and RA-related factors.