Use of second line drugs for the treatment of rheumatoid arthritis in Edmonton, Alberta. Patterns of prescription and longterm effectiveness

Abstract

Objective: Our purpose was to compare the patterns of prescription of 2nd line drugs for the treatment of rheumatoid arthritis (RA) among rheumatologists in Edmonton, Alberta, and to examine the longterm effectiveness of these drugs.

Methods: A 1985 inception cohort of 128 patients with RA was assessed between 1991 and 1992, using measures of disease activity, radiological scores and physical functional status. Use of different therapies was retrieved from the medical charts.

Results: All patients had seen a rheumatologist at any time between January, 1985 and December, 1991, 88% within the first 3 years of disease. Most (85%) had received at least one 2nd line drug, the majority within the first 2 years. Overall, gold salts were the most frequently prescribed drugs. Patterns of prescription varied among different rheumatologists; some drugs were never prescribed by some and very often by others (e.g., auranofin). Terminations because of toxicity and lack of efficacy were high. Methotrexate (MTX) had the lowest termination rate and sulfasalazine the highest, mostly due to lack of efficacy.

Conclusion: In this cohort, patients were treated early in the course of RA. Patterns of prescription of 2nd line drugs varied among rheumatologists. Termination rates were highest for sulfasalazine and lowest for MTX.