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Baseline factors predicting change from the initial DMARD treatment during the first 2 years of rheumatoid arthritis: experience in the ERAN inception cohort

McWilliams, Daniel F.; Kiely, Patrick D.W.; Young, Adam; Walsh, David A.

Authors

Daniel F. McWilliams

Patrick D.W. Kiely

Adam Young

David A. Walsh

Abstract

Background
Outcomes in early Rheumatoid Arthritis (RA) may be improved by rapidly establishing a stable and effective disease modifying anti-rheumatic drug (DMARD) treatment regimen. We aimed to investigate whether baseline factors and initial treatment strategies are associated with changes to the first DMARD treatment, due to either Lack of Efficacy (LoE) or Adverse Drug Reaction (ADR) within 2 years of presentation.

Methods
Reasons for changes from initial DMARD therapy within 2 years of baseline, and associated factors, were examined using logistic regression in data from the Early RA Network (ERAN) inception cohort.

Results
Data were available for 766 participants. 410 (54%) changed their initial DMARD regime within 2 years, including 230 (56%) due to Lack of Efficacy (LoE) and 139 (34%) due to Adverse Drug Reaction (ADR). The first DMARD was recorded as methotrexate monotherapy in 336 (44%), sulphasalazine monotherapy in 273 (36%), or combined methotrexate/sulphasalazine/hydroxychlorquine in 52 (7%).

Baseline predictors of changing DMARD (for all reasons) were HAQ-disability (aOR 1.44, 95% CI 1.12 – 1.86), poor mental health (aOR 1.44, 95% CI 1.16 – 1.78) and extra-articular disease (aOR 1.78, 95% CI 1.00 – 3.16). In this model, the triple combination therapy also predicted lower likelihood of DMARD change (aOR 0.30, 95% CI 0.12 – 0.79).

Subgroup analyses showed that MTX monotherapy was associated with lower risk of change due to ADR. Combination therapy conferred lower risk of change due to LoE. Poor mental health was associated with change due to ADR, and extra-articular disease, HAQ-disability at baseline, and younger age predicted LoE.

Conclusions
Our findings suggest that non-pharmacological interventions to improve disability and mental health, may reduce initial DMARD treatment failure.

Journal Article Type Article
Publication Date May 1, 2013
Journal BMC Musculoskeletal Disorders
Electronic ISSN 1471-2474
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 14
Issue May
Article Number 7
Institution Citation McWilliams, D. F., Kiely, P. D., Young, A., & Walsh, D. A. (2013). Baseline factors predicting change from the initial DMARD treatment during the first 2 years of rheumatoid arthritis: experience in the ERAN inception cohort. BMC Musculoskeletal Disorders, 14(May), doi:10.1186/1471-2474-14-153
DOI https://doi.org/10.1186/1471-2474-14-153
Keywords Rheumatoid arthritis, DMARD, Sulfasalazine, Methotrexate, Cohort
Publisher URL http://www.biomedcentral.com/1471-2474/14/153
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0




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