Factors associated with use of disease modifying agents for rheumatoid arthritis in the National Hospital and Ambulatory Medical Care Survey

Abstract

Objective We examined the treatment patterns among adults with rheumatoid arthritis (RA) and identified factors influencing access to traditional and biological disease modifying antirheumatic drugs (DMARDs). Methods We analyzed visits recorded in the National Ambulatory Medical Care Survey from 2005 to 2014 with a RA diagnosis. The primary outcome was DMARD use (traditional and/or biological). We included prescriptions of all RA-related treatments such as traditional and biological DMARDs, glucocorticoids, gold preparations, immunosuppressants, and non-steroidal anti-inflammatory drugs. Covariates in the logistic regression models included age, gender, race/ethnicity, type of health care coverage, provider type, geographic region, and number of comorbidities. Results Among 1405 visits with a RA diagnosis, 60.4% (n = 807) were prescribed DMARDs and 23.8% (n = 334) biological DMARDs. In fully adjusted models, females have 1.57 times higher odds of any DMARD use (95% confidence interval (CI): 1.02–2.46). Also, Medicare beneficiaries as compared to privately insured have 2.31 times higher odds of receiving any DMARDs (95% CI: 1.40–3.82), while visits with specialist vs. general physician are 2.38 times more associated with any DMARD use (95% CI: 1.37–4.14). For biological DMARDs, Medicare beneficiaries were at 2.58 times higher odds (95% CI: 1.42–4.70) than privately insured, while visits with specialist are at 3.37 times higher odds than general physician (95% CI: 1.40–8.23). Conclusion Visits with a specialist and Medicare beneficiaries were significantly associated with any DMARD or biological DMARD use. Additionally, contrary to prior evidence, race/ethnicity was not associated with any DMARD or biological DMARD use, which may indicate reduction in disparity of treatment access.

Provider Specialty and the Use of Disease‐Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among Older Adults in the 2005‐2016 National Ambulatory Medical Care Survey

“…The unit of analysis is the ambulatory visit associated with an RA diagnosis and not persons with RA, and RA cases are not followed longitudinally over 12 years because different individuals are sampled every year. Similar to other studies using NAMCS data with acceptable accuracy, we used up to the first three diagnoses and eight medications to evaluate DMARD use for visits likely to have been for RA ( 13 , 14 ). However, diagnosis cannot be confirmed, and medication data are not validated against the prescription date, nor do they include dosage information.…”

“…In an early study using NAMCS data from 1996 to 2007, Solomon et al showed most visits coded with RA did not have an associated DMARD prescription ( 13 ). Another study using later NAMCS data showed any DMARD use was associated with visits with specialists and Medicare beneficiaries (2005‐2014) ( 14 ). However, these studies did not focus on older adults and did not evaluate variations in DMARD prescriptions by provider specialty over time.…”

Comparison of glucocorticoids and painkiller prescribed days between rheumatoid arthritis patients receiving early and late treatment with a biological agent via a population-based cohort study.

“…Such factors as data collection interval, race, provider type (general physician vs. specialist), and type of drug coverage are associated with the use of DMARDs or biological agents among RA patients [10], and financial burden of certain expensive biological agents, usually leads to insufficient treatment among RA patients [10]. The data collection interval in this study was between 1998 and 2012, and during which period, the most available biologics agents for RA were etanercept (etanercept was available in Taiwan was since May 12, 2005) and adalimumab (adalimumab was available in Taiwan was since Aug 19, 2008).…”

“…The use of biological agents has been associated with significantly increased rates of serious infections, including opportunistic infections and bacterial infections, in most studies [9], and the outcomes of adverse drug effects has resulted in most guidelines recommending biological agents to be used in patients who had responded poorly to or who were intolerant of one or more DMARDs [10]. According to one recent study [11], autoantibodies and markers of systemic or local inflammation can be present long before clinical arthritis, and the disease process evolves long before the disease is clinically detectable, i.e., early treatment in RA patients should be associated with improved outcomes [11].…”

Immunomodulatory Effects Of Mesenchymal Stem Cells Derived From Bone Marrow, Adipose Tissue, And Umbilical Cord Tissue In Rheumatoid Arthritis

“…These symptoms are often indicators of moderate stage RA or the sequential stages.The administration of long-term treatment medications is generally delivered to patients in moderate stage RA and beyond. These include a class of drugs called disease-modifying anti-rheumatic medications (DMARDs) such as methotrexate, hydroxychloroquine, and sulfasalazine, which aid in the suppression of inflammation [36].…”