Contemporary disease modifying antirheumatic drugs (DMARD) in patients with recent onset rheumatoid arthritis in a US private practice: methotrexate as the anchor drug in 90% and new DMARD in 30% of patients

Abstract

Objective: To describe therapies with disease modifying antirheumatic drugs (DMARD) and biological agents in patients with early rheumatoid arthritis (RA) who were receiving routine clinical care in 2001 in a private practice of 5 rheumatologists in Nashville, TN, USA.

Methods: A cohort of 232 patients with initial symptoms of RA in 1998 or later were enrolled between February and October 2001 into a longterm observational study, designed to evaluate treatments and longterm outcomes of RA. The baseline evaluation included review of all DMARD that had been taken since disease onset, clinical measures on a multidimensional health assessment questionnaire, joint counts, and laboratory measures.

Results: Among the 232 patients, methotrexate (MTX) was the first DMARD used in 192 patients (82.8%), including 3 in combinations. Since initiation of the first DMARD to the study visit, over a median interval of 12.1 months, 125 (66.1%) patients of the 189 whose initial DMARD was MTX as a single DMARD continued MTX as a single DMARD, 43 (22.8%) had another DMARD or biological agent added in combination with MTX, and 21 (11.1%) discontinued MTX. Since the onset of RA, 89.2% of the patients had taken MTX, 15.9% hydroxychloroquine, 3.9% sulfasalazine, 22.0% leflunomide, 9.5% etanercept, 4.3 infliximab, and 87.0% prednisone.

Conclusion: After a median duration of 12.1 months of DMARD therapy, almost 90% of patients with recent onset RA took MTX as the anchor drug. More than 60% took MTX as a single DMARD or in combination with traditional DMARD, while 30% took leflunomide, etanercept, or infliximab, usually in combination with MTX.