Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Sep;65(9):1529-33.
doi: 10.1002/acr.21997.

Changes in use of disease-modifying antirheumatic drugs for rheumatoid arthritis in the United States during 1983-2009

Seoyoung C Kim  1 , Ed Yelin, Chris Tonner, Daniel H Solomon
Affiliations
Randomized Controlled Trial

Changes in use of disease-modifying antirheumatic drugs for rheumatoid arthritis in the United States during 1983-2009

Seoyoung C Kim et al. Arthritis Care Res (Hoboken). 2013 Sep.

Abstract

Objective: Use of nonbiologic disease-modifying antirheumatic drugs (DMARDs) and/or biologic DMARDs is generally recommended to improve the prognosis of patients with rheumatoid arthritis (RA). The objective of this study was to describe the changing trends in DMARD use for RA over the past 2 decades.

Methods: We analyzed data from an open longitudinal cohort of RA patients recruited from rheumatologists' practices in northern California. We examined baseline demographic and clinical characteristics of the participants and their long-term DMARD use through annual comprehensive structured telephone interviews.

Results: A total of 1,507 established RA patients were recruited through 5 enrollment periods between 1983 and 2009. Between 1983 and 2009, the use of any DMARD increased from 71% of all patients to 83% (P for trend < 0.0001). In 2009, 43% received a biologic DMARD, 34% were on both nonbiologic and biologic DMARDs, and 40% were treated with only nonbiologic DMARDs. The 4 most commonly used nonbiologic DMARDs in 2009 were methotrexate (49%), hydroxychloroquine (30%), leflunomide (13%), and sulfasalazine (7%). Etanercept (20%) was the most commonly used biologic DMARD in 2009, followed by infliximab (10%), adalimumab (9%), and abatacept (6%). Use of oral steroids was common (40-50%) and remained similar throughout the study period.

Conclusion: There has been a significant increase in the use of DMARDs for RA over the past 2 decades. However, 15% of the individuals with a clinical diagnosis of RA were not receiving DMARDs in 2009. Future research should focus on sociodemographic and clinical factors associated with DMARD use for RA.

PubMed Disclaimer

Conflict of interest statement

Competing interests

Kim has received research support from Takeda Pharmaceuticals North America and Pfizer and tuition support for the Pharmacoepidemiology Program at the Harvard School of Public Health funded by Pfizer and Asisa.

Solomon received research support from Abbott Immunology, Amgen and Lilly. He serves in unpaid roles on two analgesic trials sponsored by Pfizer.

Figures

Figure 1
Figure 1
Use of disease-modifying antirheumatic drugs (DMARDs) over the period 1983–2009 in Northern California. Values are percentage of patients receiving the specific DMARD categories, among 1,507 rheumatoid arthritis patients in the study cohort. Any DMARD includes treatment with either biologic DMARD (bDMARD) or non-biologic DMARD (nbDMARD). nbDMARDs include azathioprine, cyclophosphamide, cyclosporine, d-penicillamine, oral or injectable gold compounds, hydroxychloroquine, leflunomide, methotrexate and sulfasalazine; bDMARDs are defined abatacept, adalimumab, anakinra, etanercept and infliximab
Figure 2
Figure 2
Use of non-biologic disease-modifying antirheumatic drugs (nbDMARDs) over the period 1983–2009 in Northern California. Values are percentage of patients receiving specific nbDMARD agent, among 1,507 rheumatoid arthritis patients in the study cohort.
Figure 3
Figure 3
Use of biologic disease-modifying antirheumatic drugs (bDMARDs) over the period 1999–2009 in Northern California. Values are percentage of patients receiving specific bDMARD agent, among 1,507 rheumatoid arthritis patients in the study cohort.
See this image and copyright information in PMC

References

    1. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012;64:625–39. - PMC - PubMed
    1. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762–84. - PubMed
    1. Schmajuk G, Schneeweiss S, Katz JN, et al. Treatment of older adult patients diagnosed with rheumatoid arthritis: improved but not optimal. Arthritis Rheum. 2007;57:928–34. - PubMed
    1. Schmajuk G, Trivedi AN, Solomon DH, et al. Receipt of disease-modifying antirheumatic drugs among patients with rheumatoid arthritis in Medicare managed care plans. JAMA. 2011;305:480–6. - PMC - PubMed
    1. Solomon DH, Ayanian JZ, Yelin E, et al. Use of disease-modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey. Arthritis Care Res (Hoboken) 2012;64:184–9. - PMC - PubMed

Publication types

Substances