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

TUULIKKI SOKKA and THEODORE PINCUS

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. (J Rheumatol 2002;29:2521-4)

Key Indexing Terms:

EARLY RHEUMATOID ARTHRITIS
DISEASE MODIFYING ANTIRHEUMATIC DRUGS

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From Vanderbilt University, Nashville, Tennessee, USA.

Supported in part by grants from Aventis, Amgen, Pharmacia, the Jack C. Massey Foundation, the Academy of Finland, and by NIH Grant HL67964.

T. Sokka, MD, PhD, Vanderbilt University and Jyvaskyla Central Hospital; T. Pincus, MD, Vanderbilt University.

Address reprint requests to Dr. T. Sokka, Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, 203 Oxford House, Box 5, Nashville, TN 37232-4500. E-mail: tuulikki.sokka@vanderbilt.edu

Submitted February 14, 2002; revision accepted June 11, 2002.

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