Shaw Y, et al. - The objectives of this study were to scrutinize how quickly rheumatoid arthritis (RA) patients with moderate to high disease activity (MHDAS) adjust disease-modifying antirheumatic drug (DMARD) therapy in clinical practice, and whether those who adjust DMARDs within 3 months in response to MHDAS reach low disease activity or remission (LDAS) sooner. Adjusting DMARDs within 3 months was related to shorter times to LDAS, but many patients with persistent MHDAS waited for over 90 days to adjust DMARDs. Interventions are needed to address the timeliness of DMARD adjustments for RA patients with MHDAS.

Methods

• In this study, they recognized RA patients with MHDAS in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry, and conducted a competing risks regression on time to DMARD therapy adjustment and a Cox regression on time to LDAS.

Results

• In this study, they identified 538 eligible subjects with 943.5 patient-years of follow-up.
• 60% of patients with persistent MHDAS adjusted DMARDs within 3 months.
• Among all subjects, median times to DMARD adjustment and LDAS were 154 [IQR: 1-706] and 301 [140-706] days, respectively.
• Being elderly (subdistribution hazard ratio (SHR)=0.61, p=0.02), lower baseline disease activity (SHR=0.72, p<0.01), longer duration of RA (SHR=0.98, p<0.01), and biologic utilization (SHR=0.71, p<0.01) were significantly related to longer times to therapy adjustment.
• African-American race (HR=0.63, p=0.01), higher baseline disease activity (HR=0.75, p<0.01), and not adjusting DMARD therapy within 90 days (HR=0.76, p=0.01) were related to longer times to LDAS.