Patterns of Disease Modifing Antirheumatic Drug Use in a Spanish Cohort of Patients with Rheumatoid Arthritis

ISIDORO GONZALEZ-ALVARO, LORETO CARMONA, ALEJANDRO BALSA, RAIMON SANMARTI, MIGUEL A. BELMONTE, XAVIER TENA, and the EMECAR Study Group

ABSTRACT.

Objective. To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence.

Methods. Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit.

Results. At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (± SD) were: 3.40 ± 1.22, 1.6 ± 0.4, and 54.68 ± 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032).

Conclusion. Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings. (J Rheumatol 2003;30:697-704)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
DISEASE MODIFYING ANTIRHEUMATIC DRUGS
COHORT STUDY
TREATMENT DISCONTINUATION

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From the Departments of Rheumatology, Hospital Universitario de la Princesa, Hospital Clínico Universitario San Carlos, and Hospital Universitario La Paz, Madrid; Departments of Rheumatology, Hospital Clinic i Provincial and Hospital Germans Trias i Pujol, Barcelona; Department of Rheumatology, Hospital General de Castellón, Castellón, Spain; and the Sociedad Española de Reumatología and EMECAR Study Group (see Appendix).

Promoted and supported by the Spanish Society of Rheumatology. The medical department of Aventis Pharma, S.A. provided the funding for the project.

I. Gonzalez-Alvaro, MD, PhD, Staff, Hospital Universitario de la Princesa; L. Carmona, MD, PhD, Staff, Hospital Clínico Universitario San Carlos; A. Balsa, MD, PhD, Staff, Hospital Universitario La Paz; R. Sanmarti, MD, PhD, Staff, Hospital Clinic i Provincial; M.A. Belmonte, MD, PhD, Staff, Hospital General de Castellón; X. Tena, MD, Chief of Department, Hospital Germans Trias i Pujol.

Address reprint requests to Dr. I. González-Alvaro, Servicio de Reumatología, Hospital Universitario de La Princesa, C/ Diego de León 62, 28006 Madrid, Spain. E-mail: isidoro.ga@eresmas.net

Submitted June 14, 2002; revision accepted September 19, 2002.

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