Background/Purpose:  To examine drug prescribing trends for patients with rheumatoid arthritis (RA) over recent years and compare them to matched non-RA subjects.

Methods: Retrospective prescription data were examined from 2005-2014 in a population-based cohort of patients with RA and comparable non-RA subjects. Index date was 1/1/2005 for both cohorts. Drugs for or related to the treatment of RA were excluded. Comparisons between cohorts of percentages of patients with at least 1 prescription in a specific drug category/class were performed using Poisson regression models adjusted for age and sex.

Results: A total of 497 patients with RA (71% female) and 527 non-RA comparator subjects (70% female) were included in the study. Median age at index for RA and non-RA subjects was 61 years (range 25-95) and 63 years (range 26-95), respectively. Among the patients with RA, the median duration of RA at index was 7.5 years (range 0 to 24.8). Median time from index to last follow-up for both cohorts was 9.9 years. Comorbidities prior to index were similar among both cohorts with notable exceptions of peptic ulcer disease (13% non-RA vs 19% RA; p=0.006) and peripheral vascular disease (12% non-RA vs 19% RA; p=0.006). Former and/or current smoking was more common among patients with RA (55%) compared to non-RA (46%; p=0.018). The overall observed percentage of subjects who were prescribed at least 1 drug over the ten-year period was somewhat higher among the RA compared to non-RA subjects (relative risk [RR]: 1.04; 95% confidence interval [CI]: 0.99, 1.08). Over the study period, both cohorts demonstrated significant increases in the percentages of patients with at least 1 prescription (7% increase over 10 years in RA, p<0.001; 11% increase in non-RA, p<0.001). Drugs that were more common among RA than non-RA subjects included antimicrobials (50% RA vs 41% non-RA in 2014; RR: 1.24), calcium metabolism modifiers (10% RA vs 6% non-RA in 2014; RR: 1.78), thyroid hormone replacement therapy (23% RA vs 19% non-RA in 2014; RR:1.21), antidepressants (34% RA vs 27% non-RA in 2014; RR: 1.12), antiasthma/inhaled glucocorticoids (RR: 1.21), proton pump inhibitors (28% RA vs 18% non-RA in 2014; RR: 1.45), anti-ulcer (RR: 1.58), contraceptives (5% RA vs 2% non-RA in 2014; RR: 1.69), anti-hypertensives (55% RA vs 49% non-RA in 2014; RR: 1.11) and some others. Prescription drugs that were less common in RA than non-RA were statins (29% RA vs 35% non-RA in 2014; RR: 0.83) and other antilipemic drugs (RR: 0.56). Use of pregabalin/gabapentin (RR: 1:18; 95%CI: 0.98-1.44) and ophthalmic (RR: 1.10; 95%CI: 0.97-1.24) drugs was not statistically different between those with RA and non-RA subjects.

Conclusion:  There was a marked overall increase in prescriptions drugs for both RA and non-RA cohorts over the study period with some prescribing patterns differing between the cohorts. RA patients, at higher risk for cardiovascular events, were consistently prescribed less statins and non-statin antilipemic and were regularly prescribed more proton pump inhibitors than non-RA comparators. The clinical implications of these differences in prescribing patterns require further evaluation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/drug-prescribing-trends-in-adults-with-rheumatoid-arthritis-a-population-based-comparative-study-from-2005-2014/