Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: A limited number of rheumatoid arthritis (RA) patients are managed with a single disease-modifying anti-rheumatic drug (DMARD). Previous studies have suggested that DMARD naïve patients could potentially have a sustained clinical response to single DMARD therapy. However, little information has been available regarding the persistence of single agent therapy. This investigation determined the prevalence and clinical characteristics of US veterans with RA treated with a single DMARD in comparison to patients receiving multiple DMARDs alone or in combination.
Methods: Using the multi-centered observational Veterans Affairs Rheumatoid Arthritis (VARA) registry and VA pharmacy databases, US veterans receiving DMARDs and with ≥3 years of RA were identified. Patients were classified as persistent single DMARD (PS-DMARD), current single DMARDs (CS-DMARD), or combination/complex DMARD (ComCX-DMARD) groups. PS-DMARD patients were persistently treated with a single DMARD since diagnosis. CS-DMARD had received only a single DMARD for the past 12 months of observation but previously received one or more prior DMARDs as either mono-therapy or in combination. ComCX-DMARD patients received more than one DMARD within the prior 12 months of observation. The clinical characteristics, laboratory values and clinical outcomes in these three groups were compared.
Results: There were 966 VARA with ≥ 3 years RA disease duration who had received DMARDs with 55 (6%) PS-DMARD, 280 (29%) CS-DMARD and 631 (65%) ComCx-DMARD. The most commonly used DMARD in the PS-DMARD group was methotrexate (75%). However, while methotrexate was still the most dominant agent in the CS-DMARD group, the use of other agents increased, especially anti-TNF agents. PS-DMARD patients were older at onset, more likely to be seronegative, had fewer nodules and had less radiologic evidence for RA. There was not a clear difference in disease duration, smoking status, and genotype in comparison of the three groups.
|
|
PS- DMARD N=55 |
CS-DMARD N=280 |
ComCX-DMARD N=631 |
p-value |
|
Age at diagnosis |
57±16 |
52±14 |
51±14 |
0.01 |
|
Age at VARA enrollment |
68±11 |
66±11 |
63±11 |
0.01 |
|
|
|
|
|
|
|
Disease duration (years) |
15±13 |
18±12 |
17±11 |
0.06 |
|
Gender (male) |
52 (95%) |
257 (92%) |
572 (91%) |
0.25 |
|
Smoking status |
|
|
|
|
|
Never |
15 (27%) |
62 (22%) |
137 (22%) |
0.36 |
|
Former |
28 (51%) |
154 (55%) |
315 (50%) |
|
|
Current |
12 (22%) |
64 (23%) |
179 (28%) |
|
|
Education level (years) |
13±2.5 |
13±2.6 |
13±2.7 |
0.85 |
|
Rheumatoid Factor (pos) |
35(64%) |
212 (76%) |
516 (82%) |
0.01 |
|
Anti-CCP (pos) |
32 (58%) |
209 (75%) |
489 (77%) |
0.01 |
|
Rheumatoid nodules (pos) |
17 (31%) |
151 (54%) |
342 (54%) |
0.01 |
|
Radiographic changes of RA |
34 (62%) |
206 (74%) |
448 (71%) |
0.18 |
|
Shared Epitope |
|
|
|
|
|
2 copies |
12 (22%) |
58 (21%) |
141 (23%) |
0.86
|
|
1 copy |
25 (46%) |
142 (53%) |
303 (49%) |
|
|
Negative |
17 (31%) |
70 (26%) |
171 (28%) |
|
|
Most recent DAS28 Score |
2.8±1.1 |
3.4±1.4 |
3.7±1.5 |
0.01 |
|
Current DMARD Rx |
|
|
|
|
|
MTX |
41(75%) |
93 (33%) |
Complex DMARDs – not applicable
|
|
|
Hydroxychloroquine |
7 (13%) |
53 (19%) |
|
|
|
Sulfasalazine |
3 (5%) |
24 (9%) |
|
|
|
Leflunomide |
1 (2%) |
31 (11%) |
|
|
|
Anti-TNF |
3 (2%) |
55 (20%) |
|
|
|
Other DMARDs |
0 |
14 (5) (1%) |
|
Conclusion: Persistent single DMARD therapy was very rare after three years of therapy (approximately 6%) and current single DMARD therapy uncommon (approximately 28%) in this cross-sectional analysis of US veterans. Persistent single DMARD therapy was associated with older age at RA diagnosis and VARA enrollment, lower rates of sero-positive status, fewer rheumatoid nodules, and lower DAS28 scores at the most recent VARA evaluation. While CS-DMARD and ComCX-DMARD patients were very similar in presentation, no clear association was seen in smoking, gender, radiographic changes or in genotypes between all groups. These data suggest that most RA patients will require multiple DMARDs and/or a combination of concurrent DMARDs for management of their disease while persistent single DMARD therapy is very rare.
Disclosure:
J. Kruger,
None;
T. R. Mikuls,
None;
G. W. Cannon,
None.
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