ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2029

Treatment Patterns of Multimorbid Rheumatoid Arthritis Patients: Results from an International Cross-Sectional Study

Helga Radner1,2, Kazuki Yoshida3,4, Ihsane Hmamouchi5, Maxime Dougados6,7, Josef Smolen8 and Daniel H Solomon9, 1Department of Internal Medicine III; Division of Rheumatology, Medical University Vienna, Vienna, Austria, 2Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, 3Department of Rheumatology, Kameda Medical Center, Kamogawa, Japan, Kamogawa, Japan, 4Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, 5Biostatistics, Epidemiology LBRCE, Mohamed V Souissi University, Rabat, Morocco, 6Descartes University, Cochin Hospital, Paris, France, 7INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France., Paris, France, 8Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria, 9Rheumatology, Brigham and Women's Hospital, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Epidemiology and Public Health (ACR): Rheumatoid Arthritis Pathogenesis and Treatment

Session Type: Abstract Submissions (ACR)

Treatment Patterns of Multimorbid Rheumatoid Arthritis Patients: Results from an International Cross-sectional Study

Background/Purpose

The presence of multimorbidity could lead to less intensive treatment of RA. This can increase RA disease activity and worsen outcomes such as function, quality of life and mortality.

The aim of the study is to describe the treatment profile of multimorbid RA patients in contrast to patients with RA only, and compare it across different international regions.

Methods

COMORA is a cross-sectional study assessing morbidities, RA related outcomes and treatment of RA patients, recruited in 17 countries worldwide. Patients were grouped according to their multimorbidity profile assessed by a counted multimorbidity index (cMMI), enumerating the particular number of morbidities for each patient.  Treatment for RA was categorized according to the use of biologic DMARDs (bDMARD) and TNF-inhibitors (TNFi) in particular, use of synthetic DMARDs only (sDMARD), NSAID use and use of steroids for patients by their cMMI.  Adjusted logistic regression models were examined to determine the odds ratio (OR) and 95% confidence interval (CI) of use of bDMARD, TNFi, sDMARD, NSAID or steroids, based on a patient’s cMMI and global region, after adjusting for age, disease activity, disease duration, and previous DMARD therapy.

Results

The study cohort consisted of 3920 patients, and 2563 (65.4%) were multimorbid. Overall, 92.6% of the patients were on DMARD therapy, 32.7% received bDMARD; 59.2% sDMARD only; 51.1% NSAIDs and 54.8% corticosteroids. Regional differences could be observed with the most frequent use of bDMARDs in US (46.5%) and lowest frequency in North Africa (9.0%) (Figure). After adjusting for confounders in logistic regression analyses, the OR for use of bDMARDs was reduced for each additional morbidity (OR 0.90, 95%CI 0.83-0.97).  Similarly, the probability for use of TNFi was also reduced (OR 0.92, 95%CI 0.84-0.99), whereas the OR for use of sDMARD was increased (OR 1.12, 95%CI 1.04-1.21). No change of OR was found for NSAID or steroid use (Table).

Conclusion

In our cohort, differences in bDMARD prescribing exist across global regions.  After adjusting for covariates, the OR of bDMARD and TNFi use decreases 10% for each additional chronic morbid condition as assessed by cMMI, whereas the OR of sDMARD use increased, probably reflecting rheumatologists’ greater comfort using these agents in patients with a greater multimorbidity burden. 

Figure: Regional differences of current treatment status

image003.jpg

Table: Logistic regression models

Covariates

Odds Ratio (95% Confidence Interval)

bDMARD

TNFi

sDMARD

NSAIDs

Steroids

Counted multimorbidity index

0.90 (0.83-0.97)*

0.92 (0.84-1.0)*

1.12 (1.04-1.21)*

1.06 (0.99-1.34)

1.01 (0.98-1.13)

Age (years)

0.99 (0.98-1.0)

0.99 (0.98-1.0)

1.0 (0.99-1.01)

0.98 (0.97-0.99)*

1.0 (0.99-1.0)

Disease duration (years)

1.02 (1.0-1.03)*

1.03 (1.01-1.04)*

0.99 (0.98-1.0)

1.01 (1.0-1.03)*

1.0 (0.99-1.01)

Number of previous DMARDs

1.27 (1.18-1.37)*

0.94 (0.87-1.02)

0.71 (0.65-0.77)*

1.05 (0.98-1.13)*

1.21 (1.12-1.30)*

Clinical disease activity index

0.98 (0.97-0.99)*

0.96 (0.95-0.97)*

1.0 (0.99-1.01)

1.03 (1.02-1.04)*

1.04 (1.03-1.06)*

Region US= reference

REF

REF

REF

REF

REF

Region Europe

0.57 (0.38-0.85)*

0.58 (0.39-0.85)*

2.11 (1.35-3.27)*

0.94 (0.65-1.37)

2.50 (1.67-3.73)*

Region Asia

0.15 (0.10-0.23)*

0.24 (0.15-0.39)*

8.49 (5.23-13.6)*

4.22 (2.74-6.50)*

6.43 (4.10-10.1)*

Region South America

0.56 (0.34-0.94)*

0.62 (0.37-1.06)*

2.51 (1.46-4.37)*

1.75 (1.06-2.90)*

2.56 (1.52-4.33)*

Region North Africa

0.06 (0.03-0.11)*

0.03 (0.01-0.08)*

9.07 (5.34-15.4)*

0.58 (0.37-0.92)*

5.10 (3.09-8.35)*

*p<0.05

Disclosure:

H. Radner,
None;

K. Yoshida,
None;

I. Hmamouchi,
None;

M. Dougados,
None;

J. Smolen,
None;

D. H. Solomon,
None.

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