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Disease modifying anti-rheumatic drugs, biologics and corticosteroid use in older patients with rheumatoid arthritis over 20 years

Author

J Rheumatol. 2020 Aug 1;jrheum.200310. doi: 10.3899/jrheum.200310. Online ahead of print.

John G Hanly 1, Lynn Lethbridge 1

Author Information

1 Division of Rheumatology, Department of Medicine, and Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada; Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada. Address Correspondence to Dr. John G. Hanly, Division of Rheumatology, Nova Scotia Rehabilitation and Arthritis Centre, 1341 Summer Street - Suite 245, Halifax, Nova Scotia, B3H 4K4. Email: john.hanly@nshealth.ca.

Abstract

Objective: To examine changes in prescribing patterns, especially the use of corticosteroids, in patients with rheumatoid arthritis (RA) over two decades.

Methods: This was a secondary analysis of health administrative data using a previously validated dataset and case definition for RA. Cases were matched 1:4 by age and sex to controls within a population of approximately 1 million inhabitants with access to universal health care. Longitudinal data for incident and prevalent RA cases were studied between 1997 and 2017.

Results: There were 8240 RA cases (all ≥ 65 years) with a mean (SD) age 72.2 (7.5) years and 70.6% were female. Over 20 years, annual utilization of coxibs in prevalent RA cases fell with a concomitant increase in disease modifying anti-rheumatic drugs (DMARDs) and biologics. Over the same period corticosteroid use was largely unchanged. Approximately one third of patients had at least one annual prescription for corticosteroid, most frequently prednisone. The mean annual dose showed a modest reduction and the duration of utilization in each year shortened. Rheumatologists prescribed corticosteroids less frequently and in lower doses than other physician groups. For incident RA cases there was a significant fall in annual prescribed dose of prednisone by rheumatologists over time.

Conclusion: In older adults with RA the utilization of DMARDs and biologics has increased over the past 20 years. However, the use of corticosteroids has persisted. Renewed efforts are required to minimize their use in the long-term pharmacological management of RA.