Dr. Lin has received consulting fees, speaking fees, and/or honoraria (less than $10,000) from Informed Medical Decisions Foundation.
Receipt of Glucocorticoid Monotherapy Among Medicare Beneficiaries With Rheumatoid Arthritis†
Article first published online: 25 SEP 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 10, pages 1447–1455, October 2014
How to Cite
Yazdany, J., Tonner, C., Schmajuk, G., Lin, G. A. and Trivedi, A. N. (2014), Receipt of Glucocorticoid Monotherapy Among Medicare Beneficiaries With Rheumatoid Arthritis. Arthritis Care Res, 66: 1447–1455. doi: 10.1002/acr.22312
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
- Issue published online: 25 SEP 2014
- Article first published online: 25 SEP 2014
- Accepted manuscript online: 19 FEB 2014 02:10PM EST
- Manuscript Accepted: 11 FEB 2014
- Manuscript Received: 21 AUG 2013
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: K23-AR-060259, P60-AR-053308
- University of California
- San Francisco Resource Evaluation and Allocation Committee Grant Program
- Rosalind Russell Medical Research Center for Arthritis
Using disease-modifying antirheumatic drugs (DMARDs) improves outcomes in rheumatoid arthritis (RA) and is a nationally endorsed quality measure. We investigated the prevalence and predictors of receiving glucocorticoids alone for the treatment of RA in a nationwide sample of Medicare beneficiaries.
Among individuals ages ≥65 years with RA enrolled in the Part D prescription drug benefit in 2009, we compared those with ≥1 DMARD claim to those receiving glucocorticoid monotherapy, defined as no DMARD claim and an annual glucocorticoid supply of ≥180 days or an annual dose of ≥900 mg of prednisone or equivalent. We fit multivariable models to determine the sociodemographic and clinical factors associated with glucocorticoid monotherapy.
Of 8,125 beneficiaries treated for RA, 10.2% (n = 825) received glucocorticoids alone. Beneficiaries with low incomes were more likely to receive glucocorticoids alone (12.3%; 95% confidence interval [95% CI] 10.9–13.8% versus 9.4%; 95% CI 8.6–10.1%), as were those living in certain US regions. More physician office visits and hospitalizations were associated with glucocorticoid monotherapy. Individuals who had no contact with a rheumatologist were significantly more likely to receive glucocorticoids alone (17.5%; 95% CI 16.0–19.0% versus 8.5%; 95% CI 7.4–9.5% for those with no rheumatology visits versus 1–4 visits).
Approximately 1 in 10 Medicare beneficiaries treated for RA received glucocorticoids without DMARDs in 2009. Compared to DMARD users, glucocorticoid users were older, had lower incomes, were more likely to live in certain US regions, and were less likely to have seen a rheumatologist, suggesting persistent gaps in quality of care despite expanded drug coverage under Part D.